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Greenhalgh R, Klure DM, Orr TJ, Armstrong NM, Shapiro MD, Dearing MD. The desert woodrat (Neotoma lepida) induces a diversity of biotransformation genes in response to creosote bush resin. Comp Biochem Physiol C Toxicol Pharmacol 2024; 280:109870. [PMID: 38428625 PMCID: PMC11006593 DOI: 10.1016/j.cbpc.2024.109870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/26/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024]
Abstract
Liver biotransformation enzymes have long been thought to enable animals to feed on diets rich in xenobiotic compounds. However, despite decades of pharmacological research in humans and rodents, little is known about hepatic gene expression in specialized mammalian herbivores feeding on toxic diets. Leveraging a recently identified population of the desert woodrat (Neotoma lepida) found to be highly tolerant to toxic creosote bush (Larrea tridentata), we explored the expression changes of suites of biotransformation genes in response to diets enriched with varying amounts of creosote resin. Analysis of hepatic RNA-seq data indicated a dose-dependent response to these compounds, including the upregulation of several genes encoding transcription factors and numerous phase I, II, and III biotransformation families. Notably, elevated expression of five biotransformation families - carboxylesterases, cytochromes P450, aldo-keto reductases, epoxide hydrolases, and UDP-glucuronosyltransferases - corresponded to species-specific duplication events in the genome, suggesting that these genes play a prominent role in N. lepida's adaptation to creosote bush. Building on pharmaceutical studies in model rodents, we propose a hypothesis for how the differentially expressed genes are involved in the biotransformation of creosote xenobiotics. Our results provide some of the first details about how these processes likely operate in the liver of a specialized mammalian herbivore.
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Affiliation(s)
- Robert Greenhalgh
- School of Biological Sciences, University of Utah, 257 S 1400 E, Salt Lake City, UT 84112, USA.
| | - Dylan M Klure
- School of Biological Sciences, University of Utah, 257 S 1400 E, Salt Lake City, UT 84112, USA.
| | - Teri J Orr
- School of Biological Sciences, University of Utah, 257 S 1400 E, Salt Lake City, UT 84112, USA.
| | - Noah M Armstrong
- School of Biological Sciences, University of Utah, 257 S 1400 E, Salt Lake City, UT 84112, USA.
| | - Michael D Shapiro
- School of Biological Sciences, University of Utah, 257 S 1400 E, Salt Lake City, UT 84112, USA.
| | - M Denise Dearing
- School of Biological Sciences, University of Utah, 257 S 1400 E, Salt Lake City, UT 84112, USA.
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Masrouri S, Shapiro MD, Khalili D, Hadaegh F. Impact of coronary artery calcium on mortality and cardiovascular events in metabolic syndrome and diabetes among younger adults. Eur J Prev Cardiol 2024; 31:744-753. [PMID: 38323650 DOI: 10.1093/eurjpc/zwae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/08/2024]
Abstract
AIMS Whether coronary artery calcium (CAC) testing in younger individuals with metabolic syndrome (MetS) and diabetes mellitus (DM) helps predict cardiovascular disease (CVD) and death independent of traditional risk factors (RFs) remains less clear. METHODS AND RESULTS We pooled data obtained from 5174 individuals aged 38-55 years from the CARDIA (Coronary Artery Risk Development in Young Adults; n = 3047, year 20) and MESA (Multi-Ethnic Study of Atherosclerosis; n = 2127, Visit 1) studies who completed computed tomography of CAC. The mean age (SD) of participants (44.7% men) was 47.3 (4.2) years. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of CVD, coronary heart disease (CHD), and all-cause death. There were 1085 participants (21.0%) with prevalent CAC at baseline. A total of 461 (8.9%) had DM, 1025 (19.8%) had MetS without DM, and 3688 (71.3%) had neither condition. Over a median follow-up of 14.2 years, 256 (5.0%) participants died, and 304 (5.9%) CVD and 188 (3.6%) CHD events occurred. The CAC score was independently associated with incident CVD in those with DM (HR: 95% CI; 1.22: 1.08-1.38), MetS (1.18: 1.08-1.31), and neither condition (1.36: 1.26-1.46). The corresponding HRs for CAC ≥ 100 were 2.70 (1.25-5.83), 3.29 (1.87-5.79), and 6.30 (4.02-9.86), respectively. Similar associations for CHD and death were found. The impact of CAC ≥ 100 on CVD and CHD was lower in the presence of DM (P interaction < 0.05). The association of CAC with all outcomes in individuals with DM remained significant after adjusting with haemoglobin A1c levels. CONCLUSION Coronary artery calcium score is independently associated with cardiovascular events and death over nearly 15 years after screening at ages 38-55 years, with a less pronounced impact on CVD and CHD events in the presence of DM.
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Affiliation(s)
- Soroush Masrouri
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran 1985717413, Iran
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston Salem, North Carolina 27157, USA
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran 1985717413, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran 1985717413, Iran
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Minhas AMK, Sedhom R, Jean ED, Shapiro MD, Panza JA, Alam M, Virani SS, Ballantyne CM, Abramov D. Global burden of cardiovascular disease attributable to smoking, 1990-2019: an analysis of the 2019 Global Burden of Disease Study. Eur J Prev Cardiol 2024:zwae040. [PMID: 38589018 DOI: 10.1093/eurjpc/zwae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 04/10/2024]
Abstract
AIMS This study aims to investigate the trends in the global cardiovascular disease (CVD) burden attributable to smoking from 1990 to 2019. METHODS AND RESULTS Global Burden of Disease Study 2019 was used to analyse the burden of CVD attributable to smoking (i.e. ischaemic heart disease, peripheral artery disease, stroke, atrial fibrillation and flutter, and aortic aneurysm). Age-standardized mortality rates (ASMRs) per 100 000 and age-standardized disability-adjusted life year rates (ASDRs) per 100 000, as well as an estimated annual percentage change (EAPC) in ASMR and ASDR, were determined by age, sex, year, socio-demographic index (SDI), regions, and countries or territories. The global ASMR of smoking-attributed CVD decreased from 57.16/100 000 [95% uncertainty interval (UI) 54.46-59.97] in 1990 to 33.03/100 000 (95% UI 30.43-35.51) in 2019 [EAPC -0.42 (95% UI -0.47 to -0.38)]. Similarly, the ASDR of smoking-attributed CVD decreased between 1990 and 2019. All CVD subcategories showed a decline in death burden between 1990 and 2019. The burden of smoking-attributed CVD was higher in men than in women. Significant geographic and regional variations existed such that Eastern Europe had the highest ASMR and Andean Latin America had the lowest ASMR in 2019. In 2019, the ASMR of smoking-attributed CVD was lowest in high SDI regions. CONCLUSION Smoking-attributed CVD morbidity and mortality are declining globally, but significant variation persists, indicating a need for targeted interventions to reduce smoking-related CVD burden.
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Affiliation(s)
| | - Ramy Sedhom
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, 2068 Orange Tree Lane, Suite 215, Redlands, CA 92374, USA
| | - Estelle D Jean
- Department of Cardiology, Medstar Heart and Vascular Institute, Silver Springs, MD, USA
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Mahboob Alam
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan
- Baylor College of Medicine and Texas Heart Institute, Houston, TX, USA
| | | | - Dmitry Abramov
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, 2068 Orange Tree Lane, Suite 215, Redlands, CA 92374, USA
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Minhas AMK, Mathew RO, Sperling LS, Nambi V, Virani SS, Navaneethan SD, Shapiro MD, Abramov D. Prevalence of the Cardiovascular-Kidney-Metabolic Syndrome in the United States. J Am Coll Cardiol 2024:S0735-1097(24)00940-9. [PMID: 38583160 DOI: 10.1016/j.jacc.2024.03.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Affiliation(s)
| | - Roy O Mathew
- Loma Linda VA Health Care System, Loma Linda, California, USA
| | | | - Vijay Nambi
- Baylor College of Medicine, Houston, Texas, USA
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan; Baylor College of Medicine and Texas Heart Institute, Houston, Texas, USA
| | - Sankar D Navaneethan
- Baylor College of Medicine, Houston, Texas, USA; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Michael D Shapiro
- Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Dmitry Abramov
- Loma Linda University Medical Center, Loma Linda, California, USA.
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Zhou XD, Lonardo A, Pan CQ, Shapiro MD, Zheng MH. Clinical Features and Long-Term Outcomes of Patients Diagnosed with MASLD, MAFLD, or Both. J Hepatol 2024:S0168-8278(24)00223-X. [PMID: 38554846 DOI: 10.1016/j.jhep.2024.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Xiao-Dong Zhou
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | | | - Calvin Q Pan
- Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China;; Institute of Hepatology, Wenzhou Medical University, Wenzhou, 325000, China;; Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, 325000, China.
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Masrouri S, Tamehri Zadeh SS, Shapiro MD, Khalili D, Hadaegh F. Impact of optimal cholesterol levels on subclinical atherosclerosis in the absence of risk factors in young adults. Atherosclerosis 2024:117520. [PMID: 38616451 DOI: 10.1016/j.atherosclerosis.2024.117520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND AIMS We aimed to assess the association of blood lipids with the prevalence, incidence, and progression of subclinical atherosclerosis among young individuals without dyslipidemia and other traditional cardiovascular risk factors (CVRFs). METHODS A total of 1270 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study aged 32-46 years free of cardiovascular disease, diabetes, hypertension, current smoking, and dyslipidemia (total cholesterol [TC] ≥ 240 mg/dL, triglycerides [TG] ≥ 150 mg/dL, low-density lipoprotein cholesterol [LDL-C] ≥ 160 mg/dL, high-density lipoprotein cholesterol [HDL-C] < 40 mg/dL, or taking lipid-lowering medications) were included. A subgroup with optimal lipids within the low-CVRF group was defined with TC < 200 mg/dL, LDL-C < 100 mg/dL, non-HDL-C < 130 mg/dL, and women with HDL-C ≥ 50 mg/dL. RESULTS 1-SD higher TC (25.9 mg/dL), LDL-C (24.7 mg/dL), and non-HDL-C (26.6 mg/dL) were associated with a greater risk of presence (hazard ratios: 1.30-1.36), incidence (1.30-1.32), and progression (1.31-1.35) of coronary artery calcium (CAC) and a 42-44% greater odds of composite mean carotid intima-media thickness (CIMT) ≥ 75th percentile [780 μm] (p < 0.05). Repeating the analyses in a subset of participants with a CAC score of zero did not alter the association of TC, LDL-C, and non-HDL-C with CIMT. In the subgroup with optimal lipids, these lipid indices remained associated with an increased risk of presence and incidence of CAC and greater CIMT measures. CONCLUSIONS Among adults aged 32-46 years, in the absence of traditional CVRFs, elevated cholesterol levels, even within what is considered optimal, are associated with atherosclerosis and arteriopathy.
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Affiliation(s)
- Soroush Masrouri
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran, 1985717413, Iran
| | - Seyed Saeed Tamehri Zadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran, 1985717413, Iran
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC, 27157, USA.
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran, 1985717413, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran, 1985717413, Iran.
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Shapiro MD, Dominy NJ, Kardon G, Letsou A. Science at Sundance 2024 Love Me, S am Zuchero and Andy Zuchero, directors, ShivHans Pictures, 2024, 92 minutes. Ibelin, Benjamin Ree, director, Medieoperatørene, 2024, 104 minutes. The Battle for Laikipia, Daphne Matziaraki and Peter Murimi, directors, We Are Not the Machine Ltd, 2023, 94 minutes. Eternal You, Hans Block and Moritz Riesewieck, directors, Gebrueder Beetz Filmproduktion, 2023, 87 minutes. Nocturnes, Anirban Dutta and Anupama Srinivasan, directors, Sandbox Films, 2024, 83 minutes. Super/Man: The Christopher Reeve Story, Ian Bonhôte and Peter Ettedgui, directors, Words+Pictures/Passion Pictures/Misfits Entertainment, 2024, 104 minutes. Agent of Happiness, Arun Bhattarai and Dorottya Zurbó, directors, Sound Pictures, 2024, 94 minutes. Science 2024; 383:1052-1056. [PMID: 38452092 DOI: 10.1126/science.ado5075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Michael D Shapiro
- The reviewer is at the School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Nathaniel J Dominy
- The reviewer is at the Department of Anthropology, Dartmouth College, Hanover, NH 03755, USA
| | - Gabrielle Kardon
- The reviewer is at the Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Anthea Letsou
- The reviewer is at the Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
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Maclary ET, Holt C, Concepcion GT, Sović I, Vickrey AI, Yandell M, Kronenberg Z, Shapiro MD. Assembly and annotation of 2 high-quality columbid reference genomes from sequencing of a Columba livia × Columba guinea F1 hybrid. G3 (Bethesda) 2024; 14:jkad280. [PMID: 38066578 PMCID: PMC10849363 DOI: 10.1093/g3journal/jkad280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
Pigeons and doves (family Columbidae) are one of the most diverse extant avian lineages, and many species have served as key models for evolutionary genomics, developmental biology, physiology, and behavioral studies. Building genomic resources for columbids is essential to further many of these studies. Here, we present high-quality genome assemblies and annotations for 2 columbid species, Columba livia and Columba guinea. We simultaneously assembled C. livia and C. guinea genomes from long-read sequencing of a single F1 hybrid individual. The new C. livia genome assembly (Cliv_3) shows improved completeness and contiguity relative to Cliv_2.1, with an annotation incorporating long-read IsoSeq data for more accurate gene models. Intensive selective breeding of C. livia has given rise to hundreds of breeds with diverse morphological and behavioral characteristics, and Cliv_3 offers improved tools for mapping the genomic architecture of interesting traits. The C. guinea genome assembly is the first for this species and is a new resource for avian comparative genomics. Together, these assemblies and annotations provide improved resources for functional studies of columbids and avian comparative genomics in general.
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Affiliation(s)
- Emily T Maclary
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Carson Holt
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | | | - Ivan Sović
- Pacific Biosciences, Menlo Park, CA 94025, USA
- Digital BioLogic d.o.o, Ivanić-Grad 10310, Croatia
| | - Anna I Vickrey
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Mark Yandell
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | | | - Michael D Shapiro
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
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Rikhi R, Schaich CL, Hafzalla GW, Patel NA, Tannenbaum JE, German CA, Polonsky T, Tsai MY, Ahmad MI, Islam T, Chevli PA, Shapiro MD. Small Dense Low-Density Lipoprotein Cholesterol and Coronary Artery Calcification in the Multi-Ethnic Study of Atherosclerosis. Eur J Prev Cardiol 2024:zwae049. [PMID: 38323698 DOI: 10.1093/eurjpc/zwae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 02/08/2024]
Abstract
AIM Elevated small dense-LDL-cholesterol (sd-LDL-C) increases atherosclerotic cardiovascular disease (CVD) risk. Although coronary artery calcium (CAC) is widely used for predicting CVD events, few studies have examined the relationship between sd-LDL-C and CAC. METHODS This study included 4672 individuals with directly-measured baseline sd-LDL-C and CAC from the Multi-Ethnic Study of Atherosclerosis (mean [SD] age: 61.9 [10.4] years; 52.5% women; 47.3% with baseline CAC [mean score >0]). We used multivariable general linear models and restricted cubic splines with goodness of fit testing to evaluate the association of sd-LDL-C with the presence of CAC. Odds ratios (OR [95% CI]) were adjusted for demographics and cardiovascular risk factors, including estimated total LDL-C. RESULTS Higher quartiles of sd-LDL-C were associated with presence of CAC, even after accounting for total LDL-C. Compared to the lowest quartile of sd-LDL-C, participants in Quartiles 2, 3 and 4 had higher odds for the presence of baseline CAC (Quartile 2 OR: 1.24 [1.00, 1.53]; Quartile 3 OR: 1.51 [1.19, 1.93]; and Quartile 4 OR 1.59 [1.17, 2.16]). Splines suggested a quadratic curvilinear relationship of continuous sd-LDL-C with CAC after adjustment for demographics and CVD risk factors (quadratic vs. first-order sd-LDL-C terms likelihood ratio test: p=0.015), but not after accounting for total LDL-C (quadratic vs. first-order terms: p=0.156). CONCLUSIONS In a large, multi-ethnic sample without known CVD, higher sd-LDL-C was associated with the presence of CAC, above and beyond total LDL-C. Whether selective direct measurement of sd-LDL-C is indicated to refine cardiovascular risk assessment in primary prevention warrants further investigation.
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Affiliation(s)
- Rishi Rikhi
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christopher L Schaich
- Department of Surgery, Hypertension and Vascular Research Centre, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - George W Hafzalla
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Nisha A Patel
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jordan E Tannenbaum
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Charles A German
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois, USA
| | - Tamar Polonsky
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Muhammad I Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Tareq Islam
- Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA
| | - Parag A Chevli
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Zhou XD, Chen QF, Targher G, Byrne CD, Shapiro MD, Tian N, Xiao T, Sung KC, Lip GYH, Zheng MH. High-Sensitivity C-Reactive Protein Is Associated With Heart Failure Hospitalization in Patients With Metabolic Dysfunction-Associated Fatty Liver Disease and Normal Left Ventricular Ejection Fraction Undergoing Coronary Angiography. J Am Heart Assoc 2024; 13:e032997. [PMID: 38240197 DOI: 10.1161/jaha.123.032997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Systemic chronic inflammation plays a role in the pathophysiology of both heart failure with preserved ejection fraction (HFpEF) and metabolic dysfunction-associated fatty liver disease. This study aimed to investigate whether serum hs-CRP (high-sensitivity C-reactive protein) levels were associated with the future risk of heart failure (HF) hospitalization in patients with metabolic dysfunction-associated fatty liver disease and a normal left ventricular ejection fraction. METHODS AND RESULTS The study enrolled consecutive individuals with metabolic dysfunction-associated fatty liver disease and normal left ventricular ejection fraction who underwent coronary angiography for suspected coronary heart disease. The study population was subdivided into non-HF, pre-HFpEF, and HFpEF groups at baseline. The study outcome was time to the first hospitalization for HF. In 10 019 middle-aged individuals (mean age, 63.3±10.6 years; 38.5% women), the prevalence rates of HFpEF and pre-HFpEF were 34.2% and 34.5%, with a median serum hs-CRP level of 4.5 mg/L (interquartile range, 1.9-10 mg/L) and 5.0 mg/L (interquartile range, 2.1-10.1 mg/L), respectively. Serum hs-CRP levels were significantly higher in the pre-HFpEF and HFpEF groups than in the non-HF group. HF hospitalizations occurred in 1942 (19.4%) patients over a median of 3.2 years, with rates of 3.7% in non-HF, 20.8% in pre-HFpEF, and 32.1% in HFpEF, respectively. Cox regression analyses showed that patients in the highest hs-CRP quartile had a ≈4.5-fold increased risk of being hospitalized for HF compared with those in the lowest hs-CRP quartile (adjusted-hazard ratio, 4.42 [95% CI, 3.72-5.25]). CONCLUSIONS There was a high prevalence of baseline pre-HFpEF and HFpEF in patients with metabolic dysfunction-associated fatty liver disease and suspected coronary heart disease. There was an increased risk of HF hospitalization in those with elevated hs-CRP levels.
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Affiliation(s)
- Xiao-Dong Zhou
- Department of Cardiovascular Medicine, The Heart Center The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Qin-Fen Chen
- Medical Care Center The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province Wenzhou Medical University Wenzhou China
| | - Giovanni Targher
- Department of Medicine University of Verona Italy
- Metabolic Diseases Research Unit IRCCS Sacro Cuore-Don Calabria Hospital Negrar di Valpolicella (VR) Italy
| | - Christopher D Byrne
- Southampton National Institute for Health and Care Research Biomedical Research Centre University Hospital Southampton, and University of Southampton, Southampton General Hospital Southampton United Kingdom
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine Wake Forest University School of Medicine Winston-Salem NC
| | - Na Tian
- MAFLD Research Center, Department of Hepatology The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Tie Xiao
- MAFLD Research Center, Department of Hepatology The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Ki-Chul Sung
- Department of Internal Medicine, Division of Cardiology Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United Kingdom
- Danish Center for Health Services Research, Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Institute of Hepatology Wenzhou Medical University Wenzhou China
- Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province Wenzhou China
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Miles J, Scotti A, Castagna F, Kuno T, Leone PP, Coisne A, Ludwig S, Lavie CJ, Joshi PH, Latib A, Garcia MJ, Rodriguez CJ, Shapiro MD, Virani SS, Slipczuk L. Long-Term Mortality in Patients With Severe Hypercholesterolemia Phenotype From a Racial and Ethnically Diverse US Cohort. Circulation 2024; 149:417-426. [PMID: 37970713 PMCID: PMC10872875 DOI: 10.1161/circulationaha.123.064566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Tools for mortality prediction in patients with the severe hypercholesterolemia phenotype (low-density lipoprotein cholesterol ≥190 mg/dL) are limited and restricted to specific racial and ethnic cohorts. We sought to evaluate the predictors of long-term mortality in a large racially and ethnically diverse US patient cohort with low-density lipoprotein cholesterol ≥190 mg/dL. METHODS We conducted a retrospective analysis of all patients with a low-density lipoprotein cholesterol ≥190 mg/dL seeking care at Montefiore from 2010 through 2020. Patients <18 years of age or with previous malignancy were excluded. The primary end point was all-cause mortality. Analyses were stratified by age, sex, and race and ethnicity. Patients were stratified by primary and secondary prevention. Cox regression analyses were used to adjust for demographic, clinical, and treatment variables. RESULTS A total of 18 740 patients were included (37% non-Hispanic Black, 30% Hispanic, 12% non-Hispanic White, and 2% non-Hispanic Asian patients). The mean age was 53.9 years, and median follow-up was 5.2 years. Both high-density lipoprotein cholesterol and body mass index extremes were associated with higher mortality in univariate analyses. In adjusted models, higher low-density lipoprotein cholesterol and triglyceride levels were associated with an increased 9-year mortality risk (adjusted hazard ratio [HR], 1.08 [95% CI, 1.05-1.11] and 1.04 [95% CI, 1.02-1.06] per 20-mg/dL increase, respectively). Clinical factors associated with higher mortality included male sex (adjusted HR, 1.31 [95% CI, 1.08-1.58]), older age (adjusted HR, 1.19 per 5-year increase [95% CI, 1.15-1.23]), hypertension (adjusted HR, 2.01 [95% CI, 1.57-2.57]), chronic kidney disease (adjusted HR, 1.68 [95% CI, 1.36-2.09]), diabetes (adjusted HR, 1.79 [95% CI, 1.50-2.15]), heart failure (adjusted HR, 1.51 [95% CI, 1.16-1.95]), myocardial infarction (adjusted HR, 1.41 [95% CI, 1.05-1.90]), and body mass index <20 kg/m2 (adjusted HR, 3.36 [95% CI, 2.29-4.93]). A significant survival benefit was conferred by lipid-lowering therapy (adjusted HR, 0.57 [95% CI, 0.42-0.77]). In the primary prevention group, high-density lipoprotein cholesterol <40 mg/dL was independently associated with higher mortality (adjusted HR, 1.49 [95% CI, 1.06-2.09]). Temporal trend analyses showed a reduction in statin use over time (P<0.001). In the most recent time period (2019-2020), 56% of patients on primary prevention and 85% of those on secondary prevention were on statin therapy. CONCLUSIONS In a large, diverse cohort of US patients with the severe hypercholesterolemia phenotype, we identified several patient characteristics associated with increased 9-year all-cause mortality and observed a decrease in statin use over time, in particular for primary prevention. Our results support efforts geared toward early recognition and consistent treatment for patients with severe hypercholesterolemia.
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Affiliation(s)
- Jeremy Miles
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Andrea Scotti
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Francesco Castagna
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Toshiki Kuno
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Pier Pasquale Leone
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Augustin Coisne
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Sebastian Ludwig
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine. UT Southwestern Medical Center, Dallas, TX, USA
| | - Azeem Latib
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carlos J Rodriguez
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan. Section of Cardiology, Texas Heart Institute & Baylor College of Medicine, Houston, TX, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine. Bronx, NY, USA
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Minhas AMK, Kewcharoen J, Hall ME, Warraich HJ, Greene SJ, Shapiro MD, Michos ED, Sauer AJ, Abramov D. Temporal Trends in Substance Use and Cardiovascular Disease-Related Mortality in the United States. J Am Heart Assoc 2024; 13:e030969. [PMID: 38197601 PMCID: PMC10926834 DOI: 10.1161/jaha.123.030969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/25/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND There are limited data on substance use (SU) and cardiovascular disease (CVD)-related mortality trends in the United States. We aimed to evaluate SU+CVD-related deaths in the United States using the Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research database. METHODS AND RESULTS The Multiple Cause-of-Death Public Use record death certificates were used to identify deaths related to both SU and CVD. Crude, age-adjusted mortality rates, annual percent change, and average annual percent changes with a 95% CI were analyzed. Between 1999 and 2019, there were 636 572 SU+CVD-related deaths (75.6% men, 70.6% non-Hispanic White individuals, 65% related to alcohol). Age-adjusted mortality rates per 100 000 population were pronounced in men (22.5 [95% CI, 22.6-22.6]), American Indian or Alaska Native individuals (37.7 [95% CI, 37.0-38.4]), nonmetropolitan/rural areas (15.2 [95% CI, 15.1-15.3]), and alcohol-related death (9.09 [95% CI, 9.07 to 9.12]). The overall SU+CVD-related age-adjusted mortality rates increased from 9.9 (95% CI, 9.8-10.1) in 1999 to 21.4 (95% CI, 21.2-21.6) in 2019 with an average annual percent change of 4.0 (95% CI, 3.7-4.3). Increases in SU+CVD-related average annual percent change were noted across all subgroups and were pronounced among women (4.8% [95% CI, 4.5-5.1]), American Indian or Alaska Native individuals, younger individuals, nonmetropolitan areas, and cannabis and psychostimulant users. CONCLUSIONS There was a prominent increase in SU+CVD-related mortality in the United States between 1999 and 2019. Women, non-Hispanic American Indian or Alaska Native individuals, younger individuals, nonmetropolitan area residents, and users of cannabis and psychostimulants had pronounced increases in SU+CVD mortality.
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Affiliation(s)
| | - Jakrin Kewcharoen
- Division of CardiologyLoma Linda University Medical CenterLoma LindaCA
| | - Michael E. Hall
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | | | | | - Michael D. Shapiro
- Cardiovascular MedicineWake Forest University School of MedicineWinston SalemNC
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | | | - Dmitry Abramov
- Division of CardiologyLoma Linda University Medical CenterLoma LindaCA
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Mahmood T, Miles JR, Minnier J, Tavori H, DeBarber AE, Fazio S, Shapiro MD. Effect of PCSK9 inhibition on plasma levels of small dense low density lipoprotein-cholesterol and 7-ketocholesterol. J Clin Lipidol 2024; 18:e50-e58. [PMID: 37923663 PMCID: PMC10957330 DOI: 10.1016/j.jacl.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Oxidized forms of cholesterol (oxysterols) are implicated in atherogenesis and can accumulate in the body via direct absorption from food or through oxidative reactions of endogenous cholesterol, inducing the formation of LDL particles loaded with oxidized cholesterol. It remains unknown whether drastic reductions in LDL-cholesterol (LDL-C) are associated with changes in circulating oxysterols and whether small dense LDL (sdLDL) are more likely to carry these oxysterols and susceptible to the effects of PCSK9 inhibition (PCSK9i). OBJECTIVE We investigate the effect of LDL-C reduction accomplished via PCSK9i on changes in plasma levels of sdLDL-cholesterol (sdLDL-C) and a common, stable oxysterol, 7-ketocholesterol (7-KC), among 134 patients referred to our Preventive Cardiology clinic. METHODS Plasma lipid panel, sdLDL-C, and 7-KC measurements were obtained from patients before and after initiation of PCSK9i. RESULTS The intervention caused a significant lowering of LDL-C (-55.4 %). The changes in sdLDL-C levels (mean reduction 51.4 %) were highly correlated with the reductions in LDL-C levels (R = 0.829, p < 0.001). Interestingly, whereas changes in plasma free 7-KC levels with PCSK9i treatment were much smaller than (-6.6 %) and did not parallel those of LDL-C and sdLDL-C levels, they did significantly correlate with changes in triglycerides and very low-density lipoprotein-cholesterol (VLDL-C) levels (R = 0.219, p = 0.025). CONCLUSION Our findings suggest a non-preferential clearance of LDL subparticles as a consequence of LDL receptor upregulation caused by PCSK9 inhibition. Moreover, the lack of significant reduction in 7-KC with PCSK9i suggests that 7-KC may be in part carried by VLDL and lost during lipoprotein processing leading to LDL formation.
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Affiliation(s)
- Tahir Mahmood
- Oregon Health & Science University, Knight Cardiovascular Institute, Center for Preventive Cardiology, Portland, OR, USA (Dr Mahmood, Miles, Minnier, Tavori and Fazio)
| | - Joshua R Miles
- Oregon Health & Science University, Knight Cardiovascular Institute, Center for Preventive Cardiology, Portland, OR, USA (Dr Mahmood, Miles, Minnier, Tavori and Fazio)
| | - Jessica Minnier
- Oregon Health & Science University, Knight Cardiovascular Institute, Center for Preventive Cardiology, Portland, OR, USA (Dr Mahmood, Miles, Minnier, Tavori and Fazio); Oregon Health & Science University, OHSU-PSU School of Public Health, Portland, OR, USA (Dr Minnier)
| | - Hagai Tavori
- Oregon Health & Science University, Knight Cardiovascular Institute, Center for Preventive Cardiology, Portland, OR, USA (Dr Mahmood, Miles, Minnier, Tavori and Fazio)
| | - Andrea E DeBarber
- Oregon Health & Science University, University Shared Resources, Portland, OR, USA (Dr DeBarber)
| | - Sergio Fazio
- Oregon Health & Science University, Knight Cardiovascular Institute, Center for Preventive Cardiology, Portland, OR, USA (Dr Mahmood, Miles, Minnier, Tavori and Fazio)
| | - Michael D Shapiro
- Wake Forest University School of Medicine, Section on Cardiovascular Medicine, Center for Prevention of Cardiovascular Disease, Winston-Salem, NC, USA (Dr Shapiro).
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Masrouri S, Tamehri Zadeh SS, Pishgahi M, Azizi F, Shapiro MD, Hadaegh F. Kidney function decline is associated with mortality events: over a decade of follow-up from Tehran Lipid and Glucose Study. J Nephrol 2024; 37:107-118. [PMID: 37665526 DOI: 10.1007/s40620-023-01756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND To investigate the association between estimated glomerular filtration rate (eGFR) change and mortality risk in a cohort from the Middle East and North Africa region with increasing chronic kidney disease burden. METHODS We included 2210 participants aged ≥ 50 years from the prospective cohort of the Tehran Lipid and Glucose Study. The interval for eGFR measurement was between the examinations in 2002-2005 to 2009-2011, and participants were followed through March 2018. Glomerular filtration rate was estimated from serum creatinine using the CKD-EPI creatinine equation. We assessed the association of rapid kidney function decline, (defined as annual eGFR decline ≥ 3 ml/min/1.73 m2 per year); ≥ 30% eGFR decline over six years; and certain drop in kidney function (≥ 25% eGFR decline plus drop in eGFR category) with mortality outcomes. RESULTS During a median follow-up of 14.3 years after recruitment, 315 all-cause and 112 cardiovascular disease deaths were recorded. The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause death for rapid kidney function decline, ≥ 30% decline in eGFR over 6 years, and drop in kidney function were 1.68 (1.24-2.27), 2.01 (1.46-2.78), and 1.49 (1.11-1.98), respectively. The HRs of all-cause death and for rapid kidney function decline in those without and with chronic kidney disease were 1.41 (1.03-1.91) and 3.38 (1.69-6.76), respectively. Similar findings were observed regarding cardiovascular disease-related and non-cardiovascular disease-related mortality. CONCLUSIONS Estimated GFR decline is associated with an increased mortality risk, indicating its ability to provide additional prognostic information beyond traditional risk predictors in the general population.
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Affiliation(s)
- Soroush Masrouri
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran
| | - Seyed Saeed Tamehri Zadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran
| | - Mehdi Pishgahi
- Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran.
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15
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Davis EF, Crousillat DR, Peteiro J, Lopez-Sendon J, Senior R, Shapiro MD, Pellikka PA, Lyubarova R, Alfakih K, Abdul-Nour K, Anthopolos R, Xu Y, Kunichoff DM, Fleg JL, Spertus JA, Hochman J, Maron D, Picard MH, Reynolds HR. Global Longitudinal Strain as Predictor of Inducible Ischemia in No Obstructive Coronary Artery Disease in the CIAO-ISCHEMIA Study. J Am Soc Echocardiogr 2024; 37:89-99. [PMID: 37722490 PMCID: PMC10842002 DOI: 10.1016/j.echo.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Global longitudinal strain (GLS) is a sensitive marker for identifying subclinical myocardial dysfunction in obstructive coronary artery disease (CAD). Little is known about the relationship between GLS and ischemia in patients with myocardial ischemia and no obstructive CAD (INOCA). OBJECTIVES To investigate the relationship between resting GLS and ischemia on stress echocardiography (SE) in patients with INOCA. METHODS Left ventricular GLS was calculated offline on resting SE images at enrollment (n = 144) and 1-year follow-up (n = 120) in the CIAO-ISCHEMIA (Changes in Ischemia and Angina over One year in International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial screen failures with no obstructive CAD on computed tomography [CT] angiography) study, which enrolled participants with moderate or severe ischemia by local SE interpretation (≥3 segments with new or worsening wall motion abnormality and no obstructive (<50% stenosis) on coronary computed tomography angiography. RESULTS Global longitudinal strain values were normal in 83.3% at enrollment and 94.2% at follow-up. Global longitudinal strain values were not associated with a positive SE at enrollment (GLS = -21.5% positive SE vs GLS = -19.9% negative SE, P = .443) or follow-up (GLS = -23.2% positive SE vs GLS = -23.1% negative SE, P = .859). Significant change in GLS was not associated with positive SE in follow-up (P = .401). Regional strain was not associated with colocalizing ischemia at enrollment or follow-up. Changes in GLS and number of ischemic segments from enrollment to follow-up showed a modest but not clinically meaningful correlation (β = 0.41; 95% CI, 0.16, 0.67; P = .002). CONCLUSIONS In this cohort of INOCA patients, resting GLS values were largely normal and did not associate with the presence, severity, or location of stress-induced ischemia. These findings may suggest the absence of subclinical myocardial dysfunction detectable by echocardiographic strain analysis at rest in INOCA.
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Affiliation(s)
- Esther F Davis
- Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Victorian Heart Institute and Victorian Heart Hospital, Victoria, Australia
| | - Daniela R Crousillat
- Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Division of Cardiovascular Sciences, Department of Medicine, University of South Florida, Tampa, Florida; Department of Obstetrics and Gynecology, Tampa General-Heart and Vascular Institute, University of South Florida, Tampa, Florida
| | - Jesus Peteiro
- CHUAC, Universidad de A Coruña, CIBER-CV, A Coruna, Spain
| | | | - Roxy Senior
- Northwick Park Hospital-Royal Brompton Hospital, London, United Kingdom
| | - Michael D Shapiro
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | | | | | - Rebecca Anthopolos
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - Yifan Xu
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - Dennis M Kunichoff
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - Jerome L Fleg
- National Institute of Health-National Heart Lung, and Blood Institute, Bethesda, Maryland
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri
| | - Judith Hochman
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - David Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Michael H Picard
- Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Harmony R Reynolds
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York.
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Ponir C, Seals A, Caldarera T, Ip EH, German CA, Taylor Y, Moore JB, Bosworth HB, Shapiro MD, Pokharel Y. Specialty preference for cardiovascular prevention practice in the Southeast US and role of a preventive cardiologist. Postgrad Med J 2023; 100:42-49. [PMID: 37857510 DOI: 10.1093/postmj/qgad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/11/2023] [Accepted: 09/01/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) prevention is practiced concurrently by providers from several specialties. Our goal was to understand providers' preference of specialties in CVD prevention practice and the role of preventive cardiologists. MATERIALS AND METHODS Between 11 October 2021 and 1 March 2022, we surveyed providers from internal medicine, family medicine, endocrinology, and cardiology specialties to examine their preference of specialties in managing various domains of CVD prevention. We examined categorical variables using Chi square test and continuous variables using t or analysis of variance test. RESULTS Of 956 invitees, 263 from 21 health systems and 9 states responded. Majority of respondents were women (54.5%), practicing physicians (72.5%), specializing in cardiology (43.6%), and working at academic centers (51.3%). Respondents favored all specialties to prescribe statins (43.2%), ezetimibe (37.8%), sodium-glucose cotransporter-2 (SGLT2) inhibitors (30.5%), and aspirin in primary prevention (36.3%). Only 7.9% and 9.5% selected cardiologists and preventive cardiologists, respectively, to prescribe SGLT2 inhibitors. Most preferred specialists (i.e. cardiology and endocrinology) to manage advanced lipid disorders, refractory hypertension, and premature coronary heart disease. The most common conditions selected for preventive cardiologists to manage were genetic lipid disorders (17%), cardiovascular risk assessment (15%), dyslipidemia (13%), and refractory/resistant hypertension (12%). CONCLUSIONS For CVD prevention practice, providers favored all specialties to manage common conditions, specialists to manage complex conditions, and preventive cardiologists to manage advanced lipid disorders. Cardiologists were least preferred to prescribe SGLT2 inhibitor. Future research should explore reasons for selected CVD prevention practice preferences to optimize care coordination and for effective use of limited expertise.
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Affiliation(s)
- Cynthia Ponir
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, United States
| | - Austin Seals
- Section of Cardiovascular Medicine, Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, United States
| | - Trevor Caldarera
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, United States
| | - Edward H Ip
- Department of Biostatistics & Data Science, Department of Social Sciences and Health policy, Translational Science Institute, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, United States
| | - Charles A German
- Section of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, IL 60637, United States
| | - Yhenneko Taylor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC 28203, United States
| | - Justin B Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States
| | - Hayden B Bosworth
- Population Health Sciences, Duke University, Durham, NC 27701, United States
| | - Michael D Shapiro
- Section of Cardiovascular Medicine, Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, United States
| | - Yashashwi Pokharel
- Section of Cardiovascular Medicine, Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, United States
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Masrouri S, Afaghi S, Khalili D, Shapiro MD, Hadaegh F. Cumulative Blood Pressure in Early Adulthood and Coronary Artery Calcium and Carotid Intima-Media Thickness in Middle Age Among Adults With Maintained Blood Pressure of <130/80 mm Hg: A Post Hoc Analysis. J Am Heart Assoc 2023; 12:e032091. [PMID: 38063213 PMCID: PMC10863794 DOI: 10.1161/jaha.123.032091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND To examine the association of blood pressure (BP) levels with coronary artery calcium and carotid intima-media thickness (CIMT) in people with maintained BP below the hypertension range based on current definitions. METHODS AND RESULTS In this post hoc analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) prospective observational cohort study conducted in 4 US cities, we examined 1233 study participants (mean [SD] age at year 20 examination was 45.3 [3.5] years; 65.4% women). Participants with BP assessments across 20 years and untreated BP of <130/80 mm Hg were included. Multivariable logistic or linear regression models, adjusted for age, sex, race, education, diabetes, body mass index, serum creatinine, smoking, alcohol intake, physical activity, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides, were used to examine the associations between cumulative BP measures with coronary artery calcium and CIMT. Higher long-term cumulative systolic BP and pulse pressure across early adulthood were associated with higher CIMT (both P<0.001) but not coronary artery calcium in the multivariable-adjusted model. The associations remained significant even after adjustment for a single BP measurement at year 0 or year 20. The odds ratio (OR) of a maximal CIMT >1.01 mm was ≈50% higher per 1-SD increase in systolic BP (OR, 1.50 [95% CI, 1.19-1.88]) and pulse pressure (OR, 1.46 [95% CI, 1.19-1.79]). Similar findings for CIMT were observed among individuals with a coronary artery calcium score of 0 as well as those with maintained BP of <120/80 mm Hg throughout young adulthood. CONCLUSIONS Long-term cumulative systolic BP and pulse pressure across early adulthood within the nonhypertensive range were associated with adverse midlife alterations in CIMT.
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Affiliation(s)
- Soroush Masrouri
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesTehranIran
| | - Siamak Afaghi
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesTehranIran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesTehranIran
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular MedicineWake Forest University School of MedicineWinston SalemNC
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesTehranIran
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18
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Kazibwe R, Singleton MJ, Chevli PA, Kaze AD, Namutebi JH, Shapiro MD, Yeboah J. Association between physical activity and clinical outcomes in high-risk hypertension: Post-hoc analysis of SPRINT. Am J Prev Cardiol 2023; 16:100524. [PMID: 37576387 PMCID: PMC10415631 DOI: 10.1016/j.ajpc.2023.100524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Objective Engaging in physical activity (PA) is recommended to reduce the risk of morbidity and mortality in patients with hypertension. However, the association between PA and clinical outcomes in individuals with high-risk hypertension is understudied. We examined the relationship between PA and clinical outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT investigated the benefit of intensive (vs. standard) blood pressure treatment in patients with high-risk hypertension. Methods Baseline data on PA was self-reported. Vigorous-intensity PA (VPA) was categorized into 2 groups based on frequency of "Rarely or Never" and 1 or more sessions/month. Moderate-intensity PA (MPA) was also categorized into 2 groups based on average duration/day of <15 min and 15 or more minutes. Using multivariable Cox regression, we estimated the associations between PA the primary outcome which was a composite of cardiovascular events, and all-cause mortality. Results A total of 8,320 (age 67.8 ± 9.3, 34.9% women) of SPRINT participants with data on PA were included. During a median follow-up of 3.8 years, 619 primary outcome, and 419 all-cause mortality events occurred. Compared to not engaging in VPA, the risk of the primary outcome, myocardial infarction, and all-cause mortality (HR 95% CIs) associated with VPA of ≥1sessions/month was 0.79(0.65-0.94; p=0.009), 0.70(0.52-0.93; p=0.014) and 0.75(0.60-0.94; p=0.011), respectively. Similarly, the risk of the primary outcome and all-cause mortality (HR 95% CI) associated with engaging in MPA for ≥15 min/day, relative to <15 min/day was 0.76(0.63-0.93; p=0.008) and 0.80(0.62-1.02; p=0.066), respectively. Conclusion Among individuals with hypertension from the SPRINT study, VPA and MPA at a threshold of ≥1sessions/month and MPA of ≥15 min/day respectively, were both associated with a lower risk for cardiovascular events, and VPA was also associated with a reduced risk for all-cause mortality. Further studies are required to identify the optimal volume and intensity of PA in high-risk hypertension.
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Affiliation(s)
- Richard Kazibwe
- Department of Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Matthew J. Singleton
- Department of Medicine, Section on Cardiovascular Medicine, WellSpan Health, York, PA, USA
| | - Parag A. Chevli
- Department of Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
| | | | | | - Michael D. Shapiro
- Center for the Prevention of Cardiovascular Disease Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Joseph Yeboah
- Center for the Prevention of Cardiovascular Disease Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Kazibwe R, Singleton MJ, Ahmad MI, Kaze AD, Chevli PA, Namutebi JH, Kasozi RN, Asiimwe DD, Kazibwe J, Shapiro MD, Yeboah J. Association between weight variability, weight change and clinical outcomes in hypertension. Am J Prev Cardiol 2023; 16:100610. [PMID: 37942025 PMCID: PMC10630599 DOI: 10.1016/j.ajpc.2023.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/30/2023] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The effect of body weight variability (BWV) and body weight change (BWC) in high-risk individuals with hypertension, but without diabetes mellitus (DM) remains unclear. We examined the effect of BWV and BWC on the primary outcome [the composite of myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure (HF), or cardiovascular (CV) death] and all-cause mortality in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods In this post-hoc analysis, we used multivariate Cox regression models to examine the risk associated with BWV and BWC for the primary outcome in SPRINT. BWV was defined as the intra-individual average successive variability (ASV). BWC was defined as baseline weight minus final weight. Results A total of 8714 SPRINT participants (mean age 67.8 ± 9.4 years, 35.1 % women, 58.9 % Whites) with available data on body weight were included. The median follow-up was about 3.9 years (IQR, 3.3-4.4). In multivariable-adjusted Cox models, each 1 unit standard deviation (SD) of BWV was significantly associated with a higher risk for the primary outcome, all-cause mortality, HF, MI, and stroke [HR(95 % CI)]: 1.13 (1.07-1.19; p < 0.0001), 1.22 (1.14-1.30; p < 0.0001), 1.16 (1.07-1.26; p < 0.001), 1.10 (1.00-1.20; p = 0.047), and 1.15 (1.05-1.27; p = 0.005), respectively. Similarly, each 1 unit SD of BWC was significantly associated with a higher risk of the primary outcome, all-cause mortality, MI, and HF: 1.11(1.02-1.21; p = 0.017), 1.44 (1.26-1.65; p < 0.0001), 1.16 (1.01-1.32; p = 0.041) and 1.19 (1.02-1.40; p = 0.031) respectively. However, there was no significant association with CV death (for both BWV and BWC) or stroke (BWC). Conclusion In high-risk hypertension, BWV and BWC were both associated with higher risk of the primary outcome and all-cause mortality. These results further stress the clinical importance of sustained weight loss and minimizing fluctuations in weight in hypertension.
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Affiliation(s)
- Richard Kazibwe
- Department of Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Matthew J. Singleton
- Department of Medicine, Section on Cardiovascular Medicine, WellSpan Health, York, PA, USA
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | | | - Parag A. Chevli
- Department of Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Ramla N. Kasozi
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Joseph Kazibwe
- Department of Cardiology, Sheffield Teaching Hospital, Sheffield, UK
| | - Michael D. Shapiro
- Center for the Prevention of Cardiovascular Disease Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Joseph Yeboah
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Muluk P, Zhu J, Thoma F, Hay E, Marroquin O, Makani A, Aiyer A, Nasir K, Gulati M, Shapiro MD, Mulukutla S, Saeed A. Impact of Guideline-Directed Statin Intervention for Primary Prevention in Patients With Diabetes. Diabetes Care 2023; 46:2273-2277. [PMID: 37851356 DOI: 10.2337/dc23-0816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE We examined guideline-directed statin intensity (GDSI) use and atherosclerotic cardiovascular disease (ASCVD) outcomes in patients with diabetes across a contemporary health care system. RESEARCH DESIGN AND METHODS Patients without preexisting ASCVD were categorized by diabetes status and 10-year ASCVD risk (borderline [5-7.4%], intermediate [7.5-19.9%], high [≥20%]). Mean ±SD time to start of or change to GDSI was calculated. Incident ASCVD and all-cause mortality association, stratified by ASCVD risk, was calculated using Cox regression. RESULTS Among 282,298 patients, 28,807 (10.2%) had diabetes and 253,491 (89.8%) did not. Only two-thirds of intermediate- and high-risk patients with diabetes were receiving GDSI therapy at 5-year follow-up. In fully adjusted models, patients with diabetes not taking a statin (vs. GDSI) had a significantly higher risk of stroke and mortality in the intermediate- and high-risk groups (hazard ratio for mortality 1.81 [95% CI 1.58-2.07] vs. 1.41 [1.26-1.57]; P for interaction < 0.01). CONCLUSIONS Significant gaps remain in GDSI use for high-risk patients with diabetes, conferring an increased risk of ASCVD outcomes and all-cause mortality.
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Affiliation(s)
- Pallavi Muluk
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jianhui Zhu
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Floyd Thoma
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eli Hay
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Oscar Marroquin
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amber Makani
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Aryan Aiyer
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Khurram Nasir
- Houston Methodist, Houston, TX
- Weil Cornell Medical College, New York, NY
| | - Martha Gulati
- Smidt Heart Institute, Cedars Sinai, Los Angeles, CA
| | | | - Suresh Mulukutla
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Anum Saeed
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- University of Pittsburgh Medical Center, Pittsburgh, PA
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21
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Ashburn NP, Snavely AC, Rikhi R, Shapiro MD, Chado MA, Stopyra JP, Mahler SA. Preventive Cardiovascular Care for Hypercholesterolemia in US Emergency Departments: A National Missed Opportunity. Crit Pathw Cardiol 2023; 22:110-113. [PMID: 37831464 PMCID: PMC10843164 DOI: 10.1097/hpc.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Hypercholesterolemia (HCL) affects nearly half of Emergency Department (ED) patients who present with possible acute coronary syndrome (ACS). However, it is unknown whether US ED providers obtain lipid panels, calculate 10-year atherosclerotic cardiovascular disease (ASCVD) risk, and prescribe cholesterol-lowering medications for these patients. METHODS We conducted a nationwide cross-sectional ED survey from April 18, 2023, to May 12, 2023. An electronic survey assessing current preventive HCL care practices for patients being evaluated for ACS. A convenience sample was obtained by sharing the survey with ED medical directors, chairs, and senior leaders using emergency medicine professional organization listservs and snowball sampling. Responding EDs were categorized as being associated with an academic medical center (AMC) or not (non-AMC). RESULTS During the 4-week study period, 110 EDs (50 AMC and 60 non-AMC EDs) across 39 states responded. Just 1.8% (2/110) stated that their providers obtain a lipid panel on at least half of patients with possible ACS and only one ED (0.9%) responded that its providers calculate 10-year ASCVD risk and prescribe cholesterol medication for the majority of eligible patients. Most reported never obtaining lipid panels (60.9%, 67/110), calculating 10-year ASCVD risk (55.5%, 61/110), or prescribing cholesterol-lowering medications (52.7%, 58/110). CONCLUSIONS The vast majority of US ED providers do not provide preventive cardiovascular care for patients presenting with possible ACS. Most ED providers do not evaluate for HCL, calculate ASCVD risk, or prescribe cholesterol-lowering medications for these patients.
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Affiliation(s)
- Nicklaus P. Ashburn
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anna C. Snavely
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rishi Rikhi
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael D. Shapiro
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael A. Chado
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA
| | - Jason P. Stopyra
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Simon A. Mahler
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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22
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German CA, Shapiro MD. Charting a Course for Atherosclerosis Regression: Shifting the Paradigm. J Am Coll Cardiol 2023; 82:2084-2086. [PMID: 37993200 DOI: 10.1016/j.jacc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Charles A German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
| | - Michael D Shapiro
- Center for the Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Ponir C, Annabathula R, Caldarera T, Penmetsa M, Seals A, Saha A, Moore JB, Bosworth HB, Ip EH, Shapiro MD, Pokharel Y. Availability of Specialty Services for Cardiovascular Prevention Practice in the Southeastern United States. South Med J 2023; 116:848-856. [PMID: 37913802 DOI: 10.14423/smj.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES A comprehensive cardiovascular disease (CVD) prevention approach should address patients' medical, behavioral, and psychological issues. The aim of this study was to understand the clinician-reported availability of a pertinent CVD preventive workforce across various specialties using a survey study in the southeastern United States, an area with a disproportionate burden of CVD and commonly known as the Stroke Belt. METHODS We surveyed physicians, advanced practice providers (APPs), and pharmacists in internal medicine, family medicine, endocrinology, and cardiology regarding available specialists in CVD preventive practice. We examined categorical variables using the χ2 test and continuous variables using the t test/analysis of variance. RESULTS A total of 263 clinicians from 21 health systems participated (27.6% response rate, 91.5% from North Carolina). Most were women (54.5%) and physicians (72.5%) specializing in cardiology (43.6%) and working at academic centers (51.3%). Overall, most clinicians stated having adequate specialist services to manage hypertension (86.6%), diabetes mellitus (90.1%), and dyslipidemia (84%), with >50% stating having adequate specialist services for obesity, smoking cessation, diet/nutrition, and exercise counseling. Many reported working with an APP (69%) or a pharmacist (56.5%). Specialist services for exercise therapy, psychology, behavioral counseling, and preventive cardiology were less available. When examined across the four specialties, the majority reported having adequate specialist services for hypertension, diabetes mellitus, obesity, dyslipidemia, and diet/nutrition counseling. Providers from all four specialties were less likely to work with exercise therapists, psychologists, behavioral counselors, and preventive cardiologists. CONCLUSIONS A majority of providers expressed having adequate specialists for hypertension, diabetes mellitus, dyslipidemia, obesity, smoking cessation, diet/nutrition, and exercise counseling. Most worked together with APPs and pharmacists but less frequently with exercise therapists, psychologists, behavioral counselors, and preventive cardiologists. Further research should explore approaches to use and expand less commonly available specialists for optimal CVD preventive care.
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Affiliation(s)
- Cynthia Ponir
- From the Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Rahul Annabathula
- From the Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Trevor Caldarera
- From the Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Megha Penmetsa
- Division of Cardiovascular Disease, Department of Medicine, Carilion Clinic, Roanoke, Virginia
| | - Austin Seals
- Section of Cardiovascular Medicine, Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Animita Saha
- Atrium Health Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | | | | | - Edward H Ip
- Departments of Biostatistics and Data Science and Social Sciences and Health Policy, Translational Science Institute, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Michael D Shapiro
- Section of Cardiovascular Medicine, Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Yashashwi Pokharel
- Section of Cardiovascular Medicine, Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Maclary ET, Holt C, Concepcion GT, Sović I, Vickrey AI, Yandell M, Kronenberg Z, Shapiro MD. Assembly and annotation of two high-quality columbid reference genomes from sequencing of a Columba livia x Columba guinea F 1 hybrid. bioRxiv 2023:2023.10.11.561892. [PMID: 37873124 PMCID: PMC10592783 DOI: 10.1101/2023.10.11.561892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Pigeons and doves (family Columbidae) are one of the most diverse extant avian lineages, and many species have served as key models for evolutionary genomics, developmental biology, physiology, and behavioral studies. Building genomic resources for colubids is essential to further many of these studies. Here, we present high-quality genome assemblies and annotations for two columbid species, Columba livia and C. guinea. We simultaneously assembled C. livia and C. guinea genomes from long-read sequencing of a single F1 hybrid individual. The new C. livia genome assembly (Cliv_3) shows improved completeness and contiguity relative to Cliv_2.1, with an annotation incorporating long-read IsoSeq data for more accurate gene models. Intensive selective breeding of C. livia has given rise to hundreds of breeds with diverse morphological and behavioral characteristics, and Cliv_3 offers improved tools for mapping the genomic architecture of interesting traits. The C. guinea genome assembly is the first for this species and is a new resource for avian comparative genomics. Together, these assemblies and annotations provide improved resources for functional studies of columbids and avian comparative genomics in general.
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Affiliation(s)
- Emily T. Maclary
- School of Biological Sciences, University of Utah, Salt Lake City, UT, USA
| | - Carson Holt
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | | | - Ivan Sović
- Pacific Biosciences, Menlo Park, CA, USA
- Digital BioLogic d.o.o, Ivanić-Grad, Croatia
| | - Anna I. Vickrey
- School of Biological Sciences, University of Utah, Salt Lake City, UT, USA
| | - Mark Yandell
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | | | - Michael D. Shapiro
- School of Biological Sciences, University of Utah, Salt Lake City, UT, USA
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25
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Maclary ET, Wauer R, Phillips B, Brown A, Boer EF, Samani AM, Shapiro MD. An allelic series at the EDNRB2 locus controls diverse piebalding patterns in the domestic pigeon. PLoS Genet 2023; 19:e1010880. [PMID: 37862332 PMCID: PMC10588866 DOI: 10.1371/journal.pgen.1010880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023] Open
Abstract
Variation in pigment patterns within and among vertebrate species reflects underlying changes in cell migration and function that can impact health, reproductive success, and survival. The domestic pigeon (Columba livia) is an exceptional model for understanding the genetic changes that give rise to diverse pigment patterns, as selective breeding has given rise to hundreds of breeds with extensive variation in plumage color and pattern. Here, we map the genetic architecture of a suite of pigmentation phenotypes known as piebalding. Piebalding is characterized by patches of pigmented and non-pigmented feathers, and these plumage patterns are often breed-specific and stable across generations. Using a combination of quantitative trait locus mapping in F2 laboratory crosses and genome-wide association analysis, we identify a locus associated with piebalding across many pigeon breeds. This shared locus harbors a candidate gene, EDNRB2, that is a known regulator of pigment cell migration, proliferation, and survival. We discover multiple distinct haplotypes at the EDNRB2 locus in piebald pigeons, which include a mix of protein-coding, noncoding, and structural variants that are associated with depigmentation in specific plumage regions. These results identify a role for EDNRB2 in pigment patterning in the domestic pigeon, and highlight how repeated selection at a single locus can generate a diverse array of stable and heritable pigment patterns.
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Affiliation(s)
- Emily T. Maclary
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Ryan Wauer
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Bridget Phillips
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Audrey Brown
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Elena F. Boer
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Atoosa M. Samani
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Michael D. Shapiro
- School of Biological Sciences, University of Utah, Salt Lake City, Utah, United States of America
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Patel KV, Budoff MJ, Valero-Elizondo J, Lahan S, Ali SS, Taha MB, Blaha MJ, Blankstein R, Shapiro MD, Pandey A, Arias L, Feldman T, Cury RC, Cainzos-Achirica M, Shah SH, Ziffer JA, Fialkow J, Nasir K. Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida. Circ Cardiovasc Imaging 2023; 16:e015314. [PMID: 37772409 PMCID: PMC10695004 DOI: 10.1161/circimaging.123.015314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The contemporary burden and characteristics of coronary atherosclerosis, assessed using coronary computed tomography angiography (CCTA), is unknown among asymptomatic adults with diabetes and prediabetes in the United States. The pooled cohort equations and coronary artery calcium (CAC) score stratify atherosclerotic cardiovascular disease risk, but their association with CCTA findings across glycemic categories is not well established. METHODS Asymptomatic adults without atherosclerotic cardiovascular disease enrolled in the Miami Heart Study were included. Participants underwent CAC and CCTA testing and were classified into glycemic categories. Prevalence of coronary atherosclerosis (any plaque, noncalcified plaque, plaque with ≥1 high-risk feature, maximal stenosis ≥50%) assessed by CCTA was described across glycemic categories and further stratified by pooled cohort equations-estimated atherosclerotic cardiovascular disease risk and CAC score. Adjusted logistic regression was used to evaluate the associations between glycemic categories and coronary outcomes. RESULTS Among 2352 participants (49.5% women), the prevalence of euglycemia, prediabetes, and diabetes was 63%, 30%, and 7%, respectively. Coronary plaque was more commonly present across worsening glycemic categories (euglycemia, 43%; prediabetes, 58%; diabetes, 69%), and similar pattern was observed for other coronary outcomes. In adjusted analyses, compared with euglycemia, prediabetes and diabetes were each associated with higher odds of any coronary plaque (OR, 1.30 [95% CI, 1.05-1.60] and 1.75 [1.17-2.61], respectively), noncalcified plaque (OR, 1.47 [1.19-1.81] and 1.99 [1.38-2.87], respectively), and plaque with ≥1 high-risk feature (OR, 1.65 [1.14-2.39] and 2.53 [1.48-4.33], respectively). Diabetes was associated with stenosis ≥50% (OR, 3.01 [1.79-5.08]; reference=euglycemia). Among participants with diabetes and estimated atherosclerotic cardiovascular disease risk <5%, 46% had coronary plaque and 10% had stenosis ≥50%. Among participants with diabetes and CAC=0, 30% had coronary plaque and 3% had stenosis ≥50%. CONCLUSIONS Among asymptomatic adults, worse glycemic status is associated with higher prevalence and extent of coronary atherosclerosis, high-risk plaque, and stenosis. In diabetes, CAC was more closely associated with CCTA findings and informative in a larger population than the pooled cohort equations.
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Affiliation(s)
- Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
| | - Matthew J Budoff
- Harbor-UCLA Medical Center, Torrance, CA (M.J.B.)
- David Geffen School of Medicine, University of California, Los Angeles (M.J.B.)
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
- Center for Outcomes Research, Houston Methodist (J.V.-E., K.N.)
| | - Shubham Lahan
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
| | - Shozab S Ali
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
- Herbert Wertheim College of Medicine, Florida International University, Miami (S.S.A., T.F., R.C.C.)
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (M.J.B., M.C.-A., K.N.)
| | - Ron Blankstein
- Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, MA (R.B.)
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (M.D.S.)
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P.)
| | - Lara Arias
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
- Herbert Wertheim College of Medicine, Florida International University, Miami (S.S.A., T.F., R.C.C.)
| | - Ricardo C Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
- Herbert Wertheim College of Medicine, Florida International University, Miami (S.S.A., T.F., R.C.C.)
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (M.J.B., M.C.-A., K.N.)
- Department of Cardiology, Hospital del Mar and Hospital del Mar Research Institute, Barcelona, Spain (M.C.-A.)
| | - Svati H Shah
- Duke Clinical Research Institute, Durham, NC (S.H.S.)
| | - Jack A Ziffer
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
- Center for Outcomes Research, Houston Methodist (J.V.-E., K.N.)
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (M.J.B., M.C.-A., K.N.)
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Gabani M, Shapiro MD, Toth PP. The Role of Triglyceride-rich Lipoproteins and Their Remnants in Atherosclerotic Cardiovascular Disease. Eur Cardiol 2023; 18:e56. [PMID: 37860700 PMCID: PMC10583159 DOI: 10.15420/ecr.2023.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 10/21/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the world's leading cause of death. ASCVD has multiple mediators that therapeutic interventions target, such as dyslipidaemia, hypertension, diabetes and heightened systemic inflammatory tone, among others. LDL cholesterol is one of the most well-studied and established mediators targeted for primary and secondary prevention of ASCVD. However, despite the strength of evidence supporting LDL cholesterol reduction by multiple management strategies, ASCVD events can still recur, even in patients whose LDL cholesterol has been very aggressively reduced. Hypertriglyceridaemia and elevated levels of triglyceride-rich lipoproteins (TRLs) may be key contributors to ASCVD residual risk. Several observational and genetic epidemiological studies have highlighted the causal role of triglycerides within the TRLs and/or their remnant cholesterol in the development and progression of ASCVD. TRLs consist of intestinally derived chylomicrons and hepatically synthesised very LDL. Lifestyle modification has been considered the first line intervention for managing hypertriglyceridaemia. Multiple novel targeted therapies are in development, and have shown efficacy in the preclinical and clinical phases of study in managing hypertriglyceridaemia and elevated TRLs. This comprehensive review provides an overview of the biology, pathogenicity, epidemiology, and genetics of triglycerides and TRLs, and how they impact the risk for ASCVD. In addition, we provide a summary of currently available and novel emerging triglyceride-lowering therapies in development.
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Affiliation(s)
- Mohanad Gabani
- Division of Cardiology, Wake Forest Baptist HealthWinston-Salem, North Carolina, US
| | - Michael D Shapiro
- Division of Cardiology, Wake Forest Baptist HealthWinston-Salem, North Carolina, US
| | - Peter P Toth
- CGH Medical CenterSterling, Illinois, US
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, Maryland, US
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Kazibwe R, Chevli PA, Evans JK, Allison M, Michos ED, Wood AC, Ding J, Shapiro MD, Mongraw‐Chaffin M. Association Between Alcohol Consumption and Ectopic Fat in the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2023; 12:e030470. [PMID: 37681576 PMCID: PMC10547290 DOI: 10.1161/jaha.123.030470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023]
Abstract
Background The relationship between alcohol consumption and ectopic fat distribution, both known factors for cardiovascular disease, remains understudied. Therefore, we aimed to examine the association between alcohol consumption and ectopic adiposity in adults at risk for cardiovascular disease. Methods and Results In this cross-sectional analysis, we categorized alcohol intake among participants in MESA (Multi-Ethnic Study of Atherosclerosis) as follows (drinks/day): <1 (light drinking), 1 to 2 (moderate drinking), >2 (heavy drinking), former drinking, and lifetime abstention. Binge drinking was defined as consuming ≥5 drinks on 1 occasion in the past month. Visceral, subcutaneous, and intermuscular fat area, pericardial fat volume, and hepatic fat attenuation were measured using noncontrast computed tomography. Using multivariable linear regression, we examined the associations between categories of alcohol consumption and natural log-transformed fat in ectopic depots. We included 6756 MESA participants (62.1±10.2 years; 47.2% women), of whom 6734 and 1934 had chest computed tomography (pericardial and hepatic fat) and abdominal computed tomography (subcutaneous, intermuscular, and visceral fat), respectively. In adjusted analysis, heavy drinking, relative to lifetime abstention, was associated with a higher (relative percent difference) pericardial 15.1 [95% CI, 7.1-27.7], hepatic 3.4 [95% CI, 0.1-6.8], visceral 2.5 [95% CI, -10.4 to 17.2], and intermuscular 5.2 [95% CI, -6.6 to 18.4] fat but lower subcutaneous fat -3.5 [95% CI, -15.5 to 10.2]). The associations between alcohol consumption and ectopic adiposity exhibited a J-shaped pattern. Binge drinking, relative to light-to-moderate drinking, was also associated with higher ectopic fat. Conclusions Alcohol consumption had a J-shaped association with ectopic adiposity. Both heavy alcohol intake and binge alcohol drinking were associated with higher ectopic fat.
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Affiliation(s)
- Richard Kazibwe
- Department of Internal Medicine, Section on Hospital MedicineWake Forest University School of MedicineWinston SalemNCUSA
| | - Parag A. Chevli
- Department of Internal Medicine, Section on Hospital MedicineWake Forest University School of MedicineWinston SalemNCUSA
| | - Joni K. Evans
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Matthew Allison
- Department of Family MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Erin D. Michos
- Division of Cardiology, Department of MedicineJohns Hopkins School of MedicineBaltimoreMDUSA
| | - Alexis C. Wood
- USDA/ARS Children’s Nutrition Research CenterBaylor College of MedicineHoustonTXUSA
| | - Jingzhong Ding
- Department of Internal Medicine, Section on Gerontology and Geriatric MedicineWake Forest School of MedicineWinston‐SalemNCUSA
| | - Michael D. Shapiro
- Center for the Prevention of Cardiovascular Disease Section on Cardiovascular MedicineWake Forest University School of MedicineWinston‐SalemNCUSA
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Affiliation(s)
- Francisco I Farias
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Samuel M Kim
- Cardiology, New York-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Michael D Shapiro
- Cardiovascular Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Caldarera T, Ponir C, Seals A, Penmetsa M, Ip E, German CA, Virani SS, Saha A, Bosworth HB, Moore JB, Shapiro MD, Pokharel Y. Clinicians' self-reported efficacy in cardiovascular prevention practice in the southeastern United States. Future Cardiol 2023; 19:593-604. [PMID: 37916575 DOI: 10.2217/fca-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Aim: We assessed self-reported efficacy in cardiovascular prevention practice among internal medicine, family medicine, endocrinology and cardiology clinicians. Patients & methods: We emailed a 21-item questionnaire to 956 physicians, nurse practitioners, physician assistants and pharmacists. Results: 264 clinicians responded (median age: 39 years, 55% women, 47.9% specialists). Most expressed high self-efficacy in lifestyle counselling, prescribing statins, metformin, and aspirin in primary prevention, but low self-efficacy in managing specialized conditions like elevated lipoprotein(a). Compared with specialists, PCPs expressed lower self-efficacy in managing advanced lipid disorders and higher self-efficacy in prescribing sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Conclusion: Self-efficacy in cardiovascular prevention varied across specialties. Future research should explore relevant provider, clinic and system level factors to optimize cardiovascular prevention.
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Affiliation(s)
- Trevor Caldarera
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Cynthia Ponir
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Austin Seals
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA 27101
| | - Megha Penmetsa
- Division of Cardiovascular Disease, Department of Medicine, Carilion Clinic, Roanoke, VA 24014, USA
| | - Edward Ip
- Department of Biostatistics & Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Charles A German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Salim S Virani
- Department of Medicine, The Aga Khan University, Karachi, 74800, Pakistan
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Animita Saha
- Department of Internal Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Hayden B Bosworth
- Department of Population Health Science, Duke University School of Medicine, Durham, NC 27710, USA
| | - Justin B Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Michael D Shapiro
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA 27101
| | - Yashashwi Pokharel
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA 27101
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Bhatia HS, Rikhi R, Allen TS, Yeang C, Guan W, Garg PK, Tsai MY, Criqui MH, Shapiro MD, Tsimikas S. Lipoprotein(a) and the pooled cohort equations for ASCVD risk prediction: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2023; 381:117217. [PMID: 37607461 PMCID: PMC10659123 DOI: 10.1016/j.atherosclerosis.2023.117217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND AND AIMS Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) but is not included in the Pooled Cohort Equations (PCE). We aimed to assess how well the PCE predict 10-year event rates in individuals with elevated Lp(a), and whether the addition of Lp(a) improves risk prediction. METHODS We compared observed versus PCE-predicted 10-year ASCVD event rates, stratified by Lp(a) level and ASCVD risk category using Poisson regression, and evaluated the association between Lp(a) > 50 mg/dL and ASCVD risk using Cox proportional hazards models in the Multi-Ethnic Study of Atherosclerosis (MESA). We evaluated the C-index and net reclassification improvement (NRI) with addition of Lp(a) to the PCE. RESULTS The study population included 6639 individuals (20%, n = 1325 with elevated Lp(a)). The PCE accurately predicted 10-year event rates for individuals with elevated Lp(a) with observed event rates falling within predicted limits. Elevated Lp(a) was associated with increased risk of CVD events overall (HR 1.27, 95% CI 1.00-1.60), particularly in low (HR 2.45, 95% CI 1.40-4.31), and high-risk (HR 1.41, 95% CI 1.02-1.96) individuals. Continuous NRI (95% CI) with the addition of Lp(a) to the PCE for CVD was 0.0963 (0.0158-0.1953) overall, and 0.2999 (0.0876, 0.5525) among low-risk individuals. CONCLUSIONS The PCE performs well for event rate prediction in individuals with elevated Lp(a). However, Lp(a) is associated with increased CVD risk, and the addition of Lp(a) to the PCE improves risk prediction, particularly among low-risk individuals. These results lend support for increasing use of Lp(a) testing for risk assessment.
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Affiliation(s)
- Harpreet S Bhatia
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rishi Rikhi
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Tara S Allen
- Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Calvin Yeang
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Parveen K Garg
- Division of Cardiology, Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Michael H Criqui
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA; Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Sotirios Tsimikas
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Ashburn NP, Snavely AC, Stanek LS, Shapiro MD, Rikhi RR, Chado MA, Stopyra JP, Mahler SA. Emergency Department Observation Unit Patients Want Evaluation and Treatment for Hypercholesterolemia: A Health Belief Model Study. Crit Pathw Cardiol 2023; 22:91-94. [PMID: 37418345 PMCID: PMC10524196 DOI: 10.1097/hpc.0000000000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND Hypercholesterolemia (HCL) is common among emergency department (ED) and ED observation unit (EDOU) patients with chest pain but is not typically addressed in these settings. The objective of this study was to assess patient attitudes towards EDOU-based HCL care using the Health Belief Model. METHODS We conducted a cross-sectional survey study among 100 EDOU patients ≥18 years-old evaluated for chest pain in the EDOU of a tertiary care center from September 1, 2020, to November 01, 2021. Five-point Likert-scale surveys were used to assess each Health Belief Model domain: Cues to Action, Perceived Susceptibility, Perceived Barriers, Perceived Self-Efficacy, and Perceived Benefits. Responses were categorized as agree or do not agree. RESULTS The participants were 49.0% (49/100) female, 39.0% (39/100) non-white, and had a mean age of 59.0 ± 12.4 years. Most (83.0% [83/100, 95% confidence interval (CI), 74.2%-89.8%]) agreed the EDOU is an appropriate place for HCL education and 52.0% (52/100, 95% CI, 41.8%-62.1%) were interested in talking with their EDOU care team about HCL. Regarding Perceived Susceptibility, 88.0% (88/100, 95% CI, 80.0%-93.6%) believed HCL to be bad for their health, while 41.0% (41/100, 95% CI, 31.3%-51.3%) believed medication costs could be a barrier. For Perceived Self-Efficacy, 76.0% (76/100, 95% CI, 66.4%-84.0%) were receptive to taking medications. Overall, 95.0% (95/100, 95% CI, 88.7%-98.4%) believed managing HCL would benefit their health. CONCLUSIONS This Health Belief Model-based survey indicates high patient interest in EDOU-initiated HCL care. Patients reported high rates of Perceived Susceptibility, Self-Efficacy, and Benefits and a minority found HCL therapy costs a barrier.
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Affiliation(s)
- Nicklaus P. Ashburn
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna C. Snavely
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Laurie S. Stanek
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael D. Shapiro
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rishi R. Rikhi
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael A. Chado
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
| | - Jason P. Stopyra
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Simon A. Mahler
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
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Minhas AMK, Gupta K, Jain V, Kakar TS, Merchant AT, Shapiro MD, Abushamat LA, Nambi V, Virani SS. Trends in Cardiovascular Mortality in the United States from 1968 to 2019: Analysis of the CDC Wonder Database. Eur J Prev Cardiol 2023:zwad278. [PMID: 37619975 DOI: 10.1093/eurjpc/zwad278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 08/26/2023]
Affiliation(s)
| | - Kartik Gupta
- Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Vardhmaan Jain
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Tanya Singh Kakar
- Division of Cardiovascular Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Layla A Abushamat
- Department of Medicine, Baylor College of Medicine, Houston, TX USA
- Texas Heart Institute and Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, TX USA
- Texas Heart Institute and Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
- Texas Heart Institute and Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
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Rodriguez CP, Ogunmoroti O, Minhas AS, Vaidya D, Kazzi B, Osibogun O, Whelton S, Kovell LC, Harrington CM, Honigberg MC, Thamman R, Stein JH, Shapiro MD, Michos ED. Female-specific risk factors of parity and menopause age and risk of carotid plaque: the multi-ethnic study of atherosclerosis. Am J Cardiovasc Dis 2023; 13:222-234. [PMID: 37736349 PMCID: PMC10509453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/21/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Female-specific factors of grand multiparity (≥5 births) and early menopause age are associated with an increased risk of cardiovascular disease (CVD). However, mechanisms are incompletely understood. Carotid plaque is a marker of subclinical atherosclerosis and associated with increased CVD risk. We evaluated the association of female-specific factors with plaque burden. METHODS We included 2,313 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis, free of clinical CVD, whose parity and menopause age were ascertained by questionnaires and carotid plaque measured by ultrasound at baseline and 10 years later. Parity was categorized as nulliparity (reference), 1-2, 3-4 and ≥5 live births. Menopause age was categorized as <45, 45-49, 50-54 (reference) and ≥55 years. Multivariable regression was performed to evaluate the association of parity and menopause age with carotid plaque presence (yes/no) and extent [carotid plaque score (CPS)]. RESULTS The mean age was 64±9 years; 52.3% had prevalent carotid plaque at baseline. Compared to nulliparity, grand multiparity was significantly associated with prevalent carotid plaque after adjustment for CVD risk factors (prevalence ratio 1.17 (95% CI 1.03-1.35)) and progression of CPS over 10 years [percent difference 13% (95% CI 3-23)]. There was not any significant association of menopause age with carotid plaque presence or progression in fully-adjusted models. CONCLUSION In a multiethnic cohort, grand multiparity was independently associated with carotid plaque presence and progression. Early menopause, a known risk factor for CVD, was not captured by carotid plaque in this study. These findings may have implications for refining CVD risk assessment in women.
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Affiliation(s)
- Carla P Rodriguez
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Anum S Minhas
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Dhananjay Vaidya
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Brigitte Kazzi
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International UniversityMiami, FL, USA
| | - Seamus Whelton
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Lara C Kovell
- Division of Cardiology, University of Massachusetts Chan School of MedicineWorchester, MA, USA
| | - Colleen M Harrington
- Cardiology Division, Department of Medicine, Massachusetts General HospitalBoston, MA, USA
| | - Michael C Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General HospitalBoston, MA, USA
| | - Ritu Thamman
- Division of Cardiology, University of PittsburghPittsburgh, PA, USA
| | - James H Stein
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of MedicineWinston-Salem, NC, USA
| | - Erin D Michos
- Ciccarone Center for The Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore, MD, USA
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Zhou XD, Targher G, Byrne CD, Somers V, Kim SU, Chahal CAA, Wong VWS, Cai J, Shapiro MD, Eslam M, Steg PG, Sung KC, Misra A, Li JJ, Brotons C, Huang Y, Papatheodoridis GV, Sun A, Yilmaz Y, Chan WK, Huang H, Méndez-Sánchez N, Alqahtani SA, Cortez-Pinto H, Lip GYH, de Knegt RJ, Ocama P, Romero-Gomez M, Fudim M, Sebastiani G, Son JW, Ryan JD, Ikonomidis I, Treeprasertsuk S, Pastori D, Lupsor-Platon M, Tilg H, Ghazinyan H, Boursier J, Hamaguchi M, Nguyen MH, Fan JG, Goh GBB, Al Mahtab M, Hamid S, Perera N, George J, Zheng MH. An international multidisciplinary consensus statement on MAFLD and the risk of CVD. Hepatol Int 2023; 17:773-791. [PMID: 37204656 PMCID: PMC10198034 DOI: 10.1007/s12072-023-10543-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Fatty liver disease in the absence of excessive alcohol consumption is an increasingly common condition with a global prevalence of ~ 25-30% and is also associated with cardiovascular disease (CVD). Since systemic metabolic dysfunction underlies its pathogenesis, the term metabolic (dysfunction)-associated fatty liver disease (MAFLD) has been proposed for this condition. MAFLD is closely intertwined with obesity, type 2 diabetes mellitus and atherogenic dyslipidemia, which are established cardiovascular risk factors. Unlike CVD, which has received attention in the literature on fatty liver disease, the CVD risk associated with MAFLD is often underestimated, especially among Cardiologists. METHODS AND RESULTS A multidisciplinary panel of fifty-two international experts comprising Hepatologists, Endocrinologists, Diabetologists, Cardiologists and Family Physicians from six continents (Asia, Europe, North America, South America, Africa and Oceania) participated in a formal Delphi survey and developed consensus statements on the association between MAFLD and the risk of CVD. Statements were developed on different aspects of CVD risk, ranging from epidemiology to mechanisms, screening, and management. CONCULSIONS The expert panel identified important clinical associations between MAFLD and the risk of CVD that could serve to increase awareness of the adverse metabolic and cardiovascular outcomes of MAFLD. Finally, the expert panel also suggests potential areas for future research.
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Affiliation(s)
- Xiao-Dong Zhou
- Department of Cardiovascular Medicine, The Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Christopher D Byrne
- Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, and University of Southampton, Southampton General Hospital, Southampton, UK
| | - Virend Somers
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, USA
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - C Anwar A Chahal
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, USA
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BE, West Smithfield, UK
| | - Vincent Wai-Sun Wong
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia
| | - Philippe Gabriel Steg
- Université Paris -Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France
| | - Ki-Chul Sung
- Department of Internal Medicine, Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Anoop Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, National Diabetes Obesity and Cholesterol Foundation and Diabetes Foundation (India), New Delhi, India
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Carlos Brotons
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, Barcelona, Spain
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazi Road, Lunjiao Town, Shunde District, Foshan, China
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Aijun Sun
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yusuf Yilmaz
- Institute of Gastroenterology, Marmara University, Istanbul, Turkey
- Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Wah Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hui Huang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, 3025 Shennan Middle Road, Shenzhen, China
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Saleh A Alqahtani
- Liver Transplantation Unit, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, USA
| | - Helena Cortez-Pinto
- Laboratório de Nutrição e Metabolismo, Faculdade de Medicina, Clínica Universitária de Gastrenterologia, Universidade de Lisboa, Lisbon, Portugal
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Gravendijkwal 230, Room Ha 206, Rotterdam, The Netherlands
| | - Ponsiano Ocama
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Manuel Romero-Gomez
- Department of Digestive and Liver Diseases, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - Marat Fudim
- Department of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, 1001 Blvd. Décarie, Montreal, Canada
| | - Jang Won Son
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - John D Ryan
- Department of Hepatology, RCSI School of Medicine and Medical Sciences, Dublin/Beaumont Hospital, Dublin, Ireland
| | - Ignatios Ikonomidis
- Preventive Cardiology Laboratory and Cardiometabolic Clinic, Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Monica Lupsor-Platon
- Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Hasmik Ghazinyan
- Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia
| | - Jerome Boursier
- Hepato-Gastroenterology Department, University Hospital, 4 Larrey Street, 49933, Angers Cedex 09, France
- HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Japan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
| | - Jian-Gao Fan
- Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - George Boon-Bee Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Nilanka Perera
- Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia.
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China.
- Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
- Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China.
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Shapiro MD, Taub PR, Louie MJ, Lei L, Ballantyne CM. Efficacy and safety of bempedoic acid in patients with and without metabolic syndrome: Pooled analysis of data from four phase 3 clinical trials. Atherosclerosis 2023; 378:117182. [PMID: 37517922 DOI: 10.1016/j.atherosclerosis.2023.06.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND AIMS Bempedoic acid significantly lowers low-density lipoprotein cholesterol (LDL-C) in patients with hypercholesterolemia but its effects in patients with metabolic syndrome (MetS) have not been well characterized. We sought to determine the efficacy and safety of bempedoic acid in patients with hypercholesterolemia by baseline MetS status. METHODS This study used pooled data from four phase 3 studies. Using modified International Atherosclerosis Society guidelines, patients were grouped into two pools: those with and those without MetS. Patients with diabetes were excluded. Endpoints assessed change from baseline to week 12 in lipid and glycemic parameters and high-sensitivity C-reactive protein (hsCRP), and safety. RESULTS The study included 936 patients with MetS (bempedoic acid, 648; placebo, 288) and 1573 without MetS (bempedoic acid, 1037; placebo, 536). Significant placebo-corrected reductions in LDL-C were observed with bempedoic acid (p < 0.0001), with a slightly larger decrease in patients with vs. without MetS (-22.3% vs. -18.4%; interaction p = 0.0472). Compared with placebo, bempedoic acid significantly (p < 0.0001) lowered total cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B, and hsCRP, with a similar magnitude of benefit observed between MetS categories. Triglycerides increased with bempedoic acid but only to a lesser extent than with placebo in patients without MetS (placebo-corrected difference, -4.4%; p = 0.02). Only patients with MetS experienced decreases in glycated hemoglobin (-0.07%; p < 0.0001) and fasting plasma glucose (-2.4 mg/dL; p = 0.002). Safety was comparable between MetS categories and treatment groups. CONCLUSIONS These data suggest that bempedoic acid is a suitable therapy for patients with and without MetS who require additional lipid lowering.
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Affiliation(s)
- Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Pam R Taub
- Department of Cardiovascular Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | | | - Lei Lei
- Esperion Therapeutics, Inc., Ann Arbor, MI, USA
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Maclary ET, Wauer R, Phillips B, Brown A, Boer EF, Samani AM, Shapiro MD. An allelic series at the EDNRB2 locus controls diverse piebalding patterns in the domestic pigeon. bioRxiv 2023:2023.07.26.550625. [PMID: 37546953 PMCID: PMC10402103 DOI: 10.1101/2023.07.26.550625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Variation in pigment patterns within and among vertebrate species reflects underlying changes in cell migration and function that can impact health, reproductive success, and survival. The domestic pigeon (Columba livia) is an exceptional model for understanding the genetic changes that give rise to diverse pigment patterns, as selective breeding has given rise to hundreds of breeds with extensive variation in plumage color and pattern. Here, we map the genetic architecture of a suite of pigmentation phenotypes known as piebalding. Piebalding is characterized by patches of pigmented and non-pigmented feathers, and these plumage patterns are often breed-specific and stable across generations. Using a combination of quantitative trait locus mapping in F2 laboratory crosses and genome-wide association analysis, we identify a locus associated with piebalding across many pigeon breeds. This shared locus harbors a candidate gene, EDNRB2, that is a known regulator of pigment cell migration, proliferation, and survival. We discover multiple distinct haplotypes at the EDNRB2 locus in piebald pigeons, which include a mix of protein-coding, noncoding, and structural variants that are associated with depigmentation in specific plumage regions. These results identify a role for EDNRB2 in pigment patterning in the domestic pigeon, and highlight how repeated selection at a single locus can generate a diverse array of stable and heritable pigment patterns.
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Affiliation(s)
- Emily T. Maclary
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Ryan Wauer
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Bridget Phillips
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Audrey Brown
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Elena F. Boer
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Atoosa M. Samani
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Michael D. Shapiro
- School of Biological Sciences, University of Utah, Salt Lake City, UT 84112, USA
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Hammoud A, Chen H, Ivanov A, Yeboah J, Nasir K, Cainzos-Achirica M, Bertoni A, Khan SU, Blaha M, Herrington D, Shapiro MD. Implications of Social Disadvantage Score in Cardiovascular Outcomes and Risk Assessment: Findings From the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Qual Outcomes 2023; 16:e009304. [PMID: 37403692 PMCID: PMC10524792 DOI: 10.1161/circoutcomes.122.009304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/03/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Social determinants of health contribute to disparate cardiovascular outcomes, yet they have not been operationalized into the current paradigm of cardiovascular risk assessment. METHODS Data from the Multi-Ethnic Study of Atherosclerosis, which includes participants from 6 US field centers, were used to create an index of baseline Social Disadvantage Score (SDS) to explore its association with incident atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality and impact on ASCVD risk prediction. SDS, which ranges from 0 to 4, was calculated by tallying the following social factors: (1) household income less than the federal poverty level; (2) educational attainment less than a high school diploma; (3) single-living status; and (4) experience of lifetime discrimination. Cox models were used to examine the association between SDS and each outcome with adjustment for traditional cardiovascular risk factors. Changes in the discrimination and reclassification of ASCVD risk by incorporating SDS into the pooled cohort equations were examined. RESULTS A total of 6434 participants (mean age, 61.9±10.2 years; female 52.8%; non-white 60.9%) had available SDS 1733 (26.9%) with SDS 0; 2614 (40.6%) with SDS 1; 1515 (23.5%) with SDS 2; and 572 (8.9%) with SDS ≥3. In total, 775 incident ASCVD events and 1573 deaths were observed over a median follow-up of 17.0 years. Increasing SDS was significantly associated with incident ASCVD and all-cause mortality after adjusting for traditional risk factors (ASCVD: per unit increase in SDS hazard ratio, 1.15 [95% CI, 1.07-1.24]; mortality: per unit increase in SDS hazard ratio, 1.13 [95% CI, 1.08-1.19]). Adding SDS to pooled cohort equations components in a Cox model for 10-year ASCVD risk prediction did not significantly improve discrimination (P=0.208) or reclassification (P=0.112). CONCLUSIONS Although SDS is independently associated with incident ASCVD and all-cause mortality, it does not improve 10-year ASCVD risk prediction beyond pooled cohort equations.
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Affiliation(s)
- Aziz Hammoud
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alexander Ivanov
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joseph Yeboah
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Khurram Nasir
- Department of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Miguel Cainzos-Achirica
- Department of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Alain Bertoni
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Safi U. Khan
- Section of Hospital Medicine, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD
| | - David Herrington
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael D. Shapiro
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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Krittanawong C, Maitra NS, El-Sherbini AH, Shah N, Lavie CJ, Shapiro MD, Virani SS. Lipoprotein(a) in clinical practice: A guide for the clinician. Prog Cardiovasc Dis 2023; 79:28-36. [PMID: 37516261 DOI: 10.1016/j.pcad.2023.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
Cardiovascular disease (CVD) remains the leading cause of death worldwide. Serum lipoprotein(a) (Lp(a)) has been shown to be an independent and causative risk factor for atherosclerotic CVD and calcific aortic valvular disease. Lp(a) continues to be studied, with emerging insights into the epidemiology of CVD with respect to Lp(a), pathogenic mechanisms of Lp(a) and strategies to mitigate disease. There have been novel insights into genetic polymorphisms of the LPA gene, interactions between concomitant risk factors and Lp(a) based on real-world data, and metabolic pathway targets for Lp(a) reduction. This review highlights these recent advances in our understanding of Lp(a) and discusses management strategies as recommended by cardiovascular professional societies, emerging therapies for lowering Lp(a), and future directions in targeting Lp(a) to reduce CVD.
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Affiliation(s)
- Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY, United States of America.
| | - Neil Sagar Maitra
- Division of Cardiology, Scripps Clinic, La Jolla, CA, United States of America
| | - Adham H El-Sherbini
- Faculty of Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Nishant Shah
- Division of Cardiology, Duke Heart Center, Duke University, 2301 Erwin RD, Durham, NC, United States of America
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Center for Prevention of Cardiovascular Disease, Medical Center Boulevard, Winston Salem, NC, United States of America
| | - Salim S Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States of America; Office of the Vice Provost (Research), The Aga Khan University, Karachi 74800, Pakistan
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Rikhi R, Shapiro MD. Proprotein Convertase Subtilisin/Kexin Type 9 Inhibition: The Big Step Forward in Lipid Control. Eur Cardiol 2023; 18:e45. [PMID: 37456766 PMCID: PMC10345936 DOI: 10.15420/ecr.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/14/2023] [Indexed: 07/18/2023] Open
Abstract
The breakthrough discovery of proprotein convertase subtilisin/kexin type 9 (PCSK9) 20 years ago revolutionised the current understanding of cholesterol homeostasis. Genetic studies have shown that gain-of-function mutations in PCSK9 lead to elevated LDL cholesterol and increased risk of atherosclerotic cardiovascular disease, while loss-of-function mutations in PCSK9 result in lifelong low levels of circulating LDL cholesterol and dramatic reduction in atherosclerotic cardiovascular disease. Therapies inhibiting PCSK9 lead to a higher density of LDL receptor on the surface of hepatocytes, resulting in greater ability to clear circulating LDL. Thus far, randomised controlled trials have shown that subcutaneous fully human monoclonal antibodies targeting PCSK9, evolocumab and alirocumab, and PCSK9 silencing with inclisiran result in drastic reductions in LDL cholesterol. Additionally, several novel strategies to target PCSK9 are in development, including oral antibody, gene silencing, DNA base editing and vaccine therapies. This review highlights the efficacy, safety and clinical use of these various approaches in PCSK9 inhibition.
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Affiliation(s)
- Rishi Rikhi
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine Winston-Salem, NC, US
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine Winston-Salem, NC, US
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Ashburn NP, Snavely AC, Rikhi R, Shapiro MD, Chado MA, Ambrosini AP, Biglari AA, Kitchen ST, Millard MJ, Stopyra JP, Mahler SA. Rarely tested or treated but highly prevalent: Hypercholesterolemia in emergency department observation unit patients with chest pain. Am J Emerg Med 2023; 71:47-53. [PMID: 37329876 DOI: 10.1016/j.ajem.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/27/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Hypercholesterolemia (HCL) is common among Emergency Department (ED) patients with chest pain but is typically not addressed in this setting. This study aims to determine whether a missed opportunity for Emergency Department Observation Unit (EDOU) HCL testing and treatment exists. METHODS We conducted a retrospective observational cohort study of patients ≥18 years old evaluated for chest pain in an EDOU from 3/1/2019-2/28/2020. The electronic health record was used to determine demographics and if HCL testing or treatment occurred. HCL was defined by self-report or clinician diagnosis. Proportions of patients receiving HCL testing or treatment at 1-year following their ED visit were calculated. HCL testing and treatment rates at 1-year were compared between white vs. non-white and male vs. female patients using multivariable logistic regression models including age, sex, and race. RESULTS Among 649 EDOU patients with chest pain, 55.8% (362/649) had known HCL. Among patients without known HCL, 5.9% (17/287, 95% CI 3.5-9.3%) had a lipid panel during their index ED/EDOU visit and 26.5% (76/287, 95% CI 21.5-32.0%) had a lipid panel within 1-year of their initial ED/EDOU visit. Among patients with known or newly diagnosed HCL, 54.0% (229/424, 95% CI 49.1-58.8%) were on treatment within 1-year. After adjustment, testing rates were similar among white vs. non-white patients (aOR 0.71, 95% CI 0.37-1.38) and men vs. women (aOR 1.32, 95% CI 0.69-2.57). Treatment rates were similar among white vs. non-white (aOR 0.74, 95% CI 0.53-1.03) and male vs. female (aOR 1.08, 95% CI 0.77-1.51) patients. CONCLUSIONS Few patients were evaluated for HCL in the ED/EDOU or outpatient setting after their ED/EDOU encounter and only 54% of patients with HCL were on treatment during the 1-year follow-up period after the index ED/EDOU visit. These findings suggest a missed opportunity to reduce cardiovascular disease risk exists by evaluating and treating HCL in the ED or EDOU.
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Affiliation(s)
- Nicklaus P Ashburn
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Anna C Snavely
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rishi Rikhi
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael A Chado
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Amir A Biglari
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Spencer T Kitchen
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Marissa J Millard
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jason P Stopyra
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Simon A Mahler
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Joseph J, Pajewski NM, Dolor RJ, Ann Sellers M, Perdue LH, Peeples SR, Henrie AM, Woolard N, Jones WS, Benziger CP, Orkaby AR, Mixon AS, VanWormer JJ, Shapiro MD, Kistler CE, Polonsky TS, Chatterjee R, Chamberlain AM, Forman DE, Knowlton KU, Gill TM, Newby LK, Hammill BG, Cicek MS, Williams NA, Decker JE, Ou J, Rubinstein J, Choudhary G, Gazmuri RJ, Schmader KE, Roumie CL, Vaughan CP, Effron MB, Cooper-DeHoff RM, Supiano MA, Shah RC, Whittle JC, Hernandez AF, Ambrosius WT, Williamson JD, Alexander KP. Pragmatic evaluation of events and benefits of lipid lowering in older adults (PREVENTABLE): Trial design and rationale. J Am Geriatr Soc 2023; 71:1701-1713. [PMID: 37082807 PMCID: PMC10258159 DOI: 10.1111/jgs.18312] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 04/22/2023]
Abstract
Whether initiation of statins could increase survival free of dementia and disability in adults aged ≥75 years is unknown. PREVENTABLE, a double-blind, placebo-controlled randomized pragmatic clinical trial, will compare high-intensity statin therapy (atorvastatin 40 mg) with placebo in 20,000 community-dwelling adults aged ≥75 years without cardiovascular disease, disability, or dementia at baseline. Exclusion criteria include statin use in the prior year or for >5 years and inability to take a statin. Potential participants are identified using computable phenotypes derived from the electronic health record and local referrals from the community. Participants will undergo baseline cognitive testing, with physical testing and a blinded lipid panel if feasible. Cognitive testing and disability screening will be conducted annually. Multiple data sources will be queried for cardiovascular events, dementia, and disability; survival is site-reported and supplemented by a National Death Index search. The primary outcome is survival free of new dementia or persisting disability. Co-secondary outcomes are a composite of cardiovascular death, hospitalization for unstable angina or myocardial infarction, heart failure, stroke, or coronary revascularization; and a composite of mild cognitive impairment or dementia. Ancillary studies will offer mechanistic insights into the effects of statins on key outcomes. Biorepository samples are obtained and stored for future study. These results will inform the benefit of statins for increasing survival free of dementia and disability among older adults. This is a pioneering pragmatic study testing important questions with low participant burden to align with the needs of the growing population of older adults.
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Affiliation(s)
| | | | - Rowena J. Dolor
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Mary Ann Sellers
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Adam M. Henrie
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Albuquerque, NM
| | - Nancy Woolard
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Ariela R. Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, and Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Amanda S. Mixon
- Vanderbilt University Medical Center and Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
| | | | | | - Christine E. Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC
| | | | - Ranee Chatterjee
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Daniel E. Forman
- Department of Medicine, Sections of Geriatrics and Cardiology, University of Pittsburgh; Pittsburgh GRECC, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | | | - L. Kristin Newby
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Bradley G. Hammill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Jake E. Decker
- Section of Primary Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jiafu Ou
- Cardiology Division, John Cochran VA Medical Center and Cardiology Division, Washington University School of Medicine, St. Louis, MO
| | - Jack Rubinstein
- Division of Cardiology, Cincinnati VAMC and Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Gaurav Choudhary
- Providence VA Medical Center, and Lifespan Cardiovascular Institute, and Alpert Medical School of Brown University, Providence RI
| | - Raúl J. Gazmuri
- Captain James A. Lovell Federal Health Care Center and Rosalind Franklin University of Medicine and Science, Chicago, IL
| | | | - Christianne L. Roumie
- Vanderbilt University Medical Center and Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
| | - Camille P. Vaughan
- Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs, and Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA
| | - Mark B. Effron
- John Ochsner Heart and Vascular Institute, The University of Queensland Ochsner Clinical School, New Orleans, LA
| | | | | | - Raj C. Shah
- Family & Preventive Medicine and the Rush Alzheimer’s Disease Center, Rush University, Chicago, IL
| | | | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Karen P. Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Issa R, Nazir S, Khan Minhas AM, Lang J, Ariss RW, Kayani WT, Khalid MU, Sperling L, Shapiro MD, Jneid H, Gupta R. Demographic and regional trends of peripheral artery disease-related mortality in the United States, 2000 to 2019. Vasc Med 2023; 28:205-213. [PMID: 36597656 DOI: 10.1177/1358863x221140151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Peripheral artery disease (PAD) is a common progressive atherosclerotic disease associated with significant morbidity and mortality in the US; however, data regarding PAD-related mortality trends are limited. This study aims to characterize contemporary trends in mortality across sociodemographic and regional groups. METHODS The Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) was queried for data regarding PAD-related deaths from 2000 to 2019 in the overall sample and different demographic (age, sex, race/ethnicity) and regional (state, urban-rural) subgroups. Crude and age-adjusted mortality rates (CMR and AAMR, respectively) per 100,000 people were calculated. Associated annual percentage changes (APC) were computed using Joinpoint Regression Program Version 4.9.0.0 trend analysis software. RESULTS Between 2000 and 2019, a total of 1,959,050 PAD-related deaths occurred in the study population. Overall, AAMR decreased from 72.8 per 100,000 in 2000 to 32.35 per 100,000 in 2019 with initially decreasing APCs followed by no significant decline from 2016 to 2019. Most demographic and regional subgroups showed initial declines in AAMRs during the study period, with many groups exhibiting no change in mortality in recent years. However, men, non-Hispanic (NH) Black or African American individuals, people aged ⩾ 85 years, and rural counties were associated with the highest AAMRs of their respective subgroups. Notably, there was an increase in crude mortality rate among individuals 25-39 years of age from 2009 to 2019. CONCLUSION Despite initial improvement, PAD-related mortality has remained stagnant in recent years. Disparities have persisted across several demographic and regional groups, requiring further investigation.
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Affiliation(s)
- Rochell Issa
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Jacob Lang
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Robert W Ariss
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Waleed Tallat Kayani
- Section of Interventional Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Mirza Umair Khalid
- Section of Interventional Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Laurence Sperling
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hani Jneid
- Section of Interventional Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Rajesh Gupta
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
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Kwapong YA, Sharma G, Valero-Elizondo J, Achirica MC, Ali SS, Blaha MJ, Blankstein R, Shapiro MD, Arias L, Budoff MJ, Feldman T, Cury RC, Mehta L, Fialkow J, Nasir K. The association of sex-specific hormones with coronary artery plaque characteristics from Miami Heart (MiHeart) study. Am J Prev Cardiol 2023; 14:100479. [PMID: 36950675 PMCID: PMC10025130 DOI: 10.1016/j.ajpc.2023.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/01/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The association of sex-specific hormones with coronary computed tomography angiography(CCTA)-based plaque characteristics in women without cardiovascular disease is not well understood. We investigated the association of sex-specific hormones with coronary artery plaque characteristics in a contemporary multiracial cohort with no clinical coronary artery disease (CAD). Methods In this cross-sectional analysis, we utilized data from 2,325 individuals with no clinical CAD from the Miami Heart (MiHeart) study. Multivariable logistic regression models were used to investigate the association of sex hormones: sex hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), free and total testosterone, estradiol, with plaque characteristics among women and men. Results Of the 1,155 women, 34.2% had any plaque and 3.4% had any high-risk plaque features (HRP) while among men (n = 1170), 63.1% had any plaque and 10.4% had HRP. Among women, estradiol and SHBG were associated with lower odds of any plaque after adjusting for age and race-ethnicity (estradiol OR per SD increase: 0.87, 95%CI: 0.76-0.98; SHBG OR per SD increase: 0.82, 95%CI: 0.72-0.93) but the significance did not persist after adjustment of cardiovascular risk factors. High free testosterone was associated with higher odds of HRP (aOR:3.48, 95%CI:1.07-11.26) but null associations for the other sex hormones with HRP, in the context of limited sample size. Among men, there were no significant associations between sex-specific hormones and plaque or HRP. Conclusion Among young to middle-aged women with no clinical CAD, increasing estradiol and SHBG were associated with lower odds of any plaque and higher free testosterone was associated with HRP. Larger cohorts may be needed to validate this.
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Affiliation(s)
- Yaa A. Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Shozab S. Ali
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ron Blankstein
- Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, MA, USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lara Arias
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Matthew J. Budoff
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Harbor UCLA, Medical Center, Torrance, CA, USA
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ricardo C. Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Laxmi Mehta
- Division of Cardiology, the Ohio State University School of Medicine, Columbus, OH, USA
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Corresponding author at: Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX 77030, USA.
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Shemesh E, Chevli PA, Islam T, German CA, Otvos J, Yeboah J, Rodriguez F, deFilippi C, Lima JAC, Blaha M, Pandey A, Vaduganathan M, Shapiro MD. Circulating ketone bodies and cardiovascular outcomes: the MESA study. Eur Heart J 2023; 44:1636-1646. [PMID: 36881667 PMCID: PMC10411932 DOI: 10.1093/eurheartj/ehad087] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/01/2023] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
AIMS Ketone bodies (KB) are an important alternative metabolic fuel source for the myocardium. Experimental and human investigations suggest that KB may have protective effects in patients with heart failure. This study aimed to examine the association between KB and cardiovascular outcomes and mortality in an ethnically diverse population free from cardiovascular disease (CVD). METHODS AND RESULTS This analysis included 6796 participants (mean age 62 ± 10 years, 53% women) from the Multi-Ethnic Study of Atherosclerosis. Total KB was measured by nuclear magnetic resonance spectroscopy. Multivariable-adjusted Cox proportional hazard models were used to examine the association of total KB with cardiovascular outcomes. At a mean follow-up of 13.6 years, after adjusting for traditional CVD risk factors, increasing total KB was associated with a higher rate of hard CVD, defined as a composite of myocardial infarction, resuscitated cardiac arrest, stroke, and cardiovascular death, and all CVD (additionally included adjudicated angina) [hazard ratio, HR (95% confidence interval, CI): 1.54 (1.12-2.12) and 1.37 (1.04-1.80) per 10-fold increase in total KB, respectively]. Participants also experienced an 87% (95% CI: 1.17-2.97) increased rate of CVD mortality and an 81% (1.45-2.23) increased rate of all-cause mortality per 10-fold increase in total KB. Moreover, a higher rate of incident heart failure was observed with increasing total KB [1.68 (1.07-2.65), per 10-fold increase in total KB]. CONCLUSION The study found that elevated endogenous KB in a healthy community-based population is associated with a higher rate of CVD and mortality. Ketone bodies could serve as a potential biomarker for cardiovascular risk assessment.
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Affiliation(s)
- Elad Shemesh
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Parag Anilkumar Chevli
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Tareq Islam
- Section on Hospital Medicine, Department of Internal Medicine, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822, USA
| | - Charles A German
- Section of Cardiology, Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 6080, Chicago, IL 60637, USA
| | | | - Joseph Yeboah
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Fatima Rodriguez
- Section on Cardiovascular Medicine, Department of Internal Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | | | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Michael Blaha
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, MA75 Francis Street, Boston, MA 20115, USA
| | - Michael D Shapiro
- Center for the Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
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Mehta A, Dixon DL, Saeed A, Kelly MS, Gulati M, Shapiro MD, Sperling LS, Virani SS. With Current Safety and Efficacy Data, Should Statins Be Made Available as Nonprescription Over-the-Counter Drugs? Curr Cardiol Rep 2023; 25:423-430. [PMID: 36971960 DOI: 10.1007/s11886-023-01861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE OF REVIEW Statins inhibit the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A reductase in the liver and reduce atherosclerotic cardiovascular disease (ASCVD) risk by enhancing low-density lipoprotein (LDL) clearance from the circulation. In this review, we discuss their efficacy, safety, and real-world utilization to make a case for reclassifying statins as nonprescription over-the-counter drugs to improve access and availability with the overarching goal of increasing statin utilization in patients most likely to benefit from this class of therapy. RECENT FINDINGS Statin efficacy for reducing risk in primary and secondary ASCVD prevention populations as well as their safety and tolerability has been thoroughly investigated in large-scale clinical trials over the past 3 decades. Despite the overwhelming scientific evidence, statins are underutilized even among those at the highest ASCVD risk. We propose a nuanced approach to use statins as nonprescription drugs that leverages a multi-disciplinary clinical model. It integrates lessons learned from experiences outside the USA with a proposed Food and Drug Administration rule change that allows nonprescription drug products with an additional condition for nonprescription use.
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Affiliation(s)
- Anurag Mehta
- VCU Health Pauley Heart Center and Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Dave L Dixon
- VCU Health Pauley Heart Center and Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Anum Saeed
- Heart and Vascular Institute, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael S Kelly
- Thomas Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
| | - Martha Gulati
- Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section On Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Salim S Virani
- Department of Medicine, The Aga Khan University, Karachi, Pakistan.
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, USA.
- Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA.
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Freeman AM, Raman SV, Aggarwal M, Maron DJ, Bhatt DL, Parwani P, Osborne J, Earls JP, Min JK, Bax JJ, Shapiro MD. Corrigendum to 'Integrating Coronary Atherosclerosis Burden and Progression with Coronary Artery Disease Risk Factors to Guide Therapeutic Decision Making' The American Journal of Medicine 136:03 (2023); 260-269.e7. Am J Med 2023:S0002-9343(23)00221-8. [PMID: 37068988 DOI: 10.1016/j.amjmed.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo.
| | - Subha V Raman
- Division of Cardiology, Indiana University School of Medicine, Indianapolis
| | - Monica Aggarwal
- Division of Cardiovascular Medicine, University of Florida, Gainesville
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | | | | | | | | | - Jeroen J Bax
- Leiden University Medical Center, Leiden, Netherlands
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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Broni EK, Ogunmoroti O, Osibogun O, Echouffo-Tcheugui JB, Chevli PA, Shapiro MD, Ndumele CE, Michos ED. Ideal Cardiovascular Health and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis (MESA). Endocr Pract 2023:S1530-891X(23)00366-X. [PMID: 37028649 DOI: 10.1016/j.eprac.2023.03.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Adipokines are hormones implicated in obesity and its cardiometabolic consequences. The concept of ideal cardiovascular health (CVH) was introduced to promote 7 key health factors and behaviors in the general population. Prior studies have found strong associations between obesity and ideal CVH. We now sought to evaluate the association between CVH and adipokines. METHODS We studied 1,842 MESA participants free of cardiovascular disease (CVD), who had 7 CVH metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and fasting blood glucose) measured at baseline and serum adipokine levels measured at a median of 2.4 years later. Each CVH metric was assigned a score of 0(poor), 1(intermediate) and 2(ideal), and summed for a total CVH score (0-14). Total CVH scores of 0-8 were considered inadequate, 9-10 average, and 11-14 optimal. We used multivariable linear regression models to assess the non-concurrent associations between CVH score and log-transformed adipokine levels. RESULTS The mean age was 62.1±9.8 years; 50.2% of participants were men. After adjusting for sociodemographic factors, a 1-unit higher CVH score was significantly associated with 4% higher adiponectin and 15% and 1% lower leptin and resistin levels. Individuals with optimal CVH scores had 27% higher adiponectin and 56% lower leptin levels compared to those with inadequate CVH scores. Similar trends were observed for those with average versus inadequate CVH scores. CONCLUSION In a multi-ethnic cohort free of CVD at baseline, individuals with average and optimal CVH scores had a more favorable adipokine profile than those with inadequate CVH.
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Affiliation(s)
- Eric K Broni
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Parag A Chevli
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Acquah I, Hagan K, Javed Z, Taha MB, Valero-Elizondo J, Nwana N, Yahya T, Sharma G, Gulati M, Hammoud A, Shapiro MD, Blankstein R, Blaha MJ, Cainzos-Achirica M, Nasir K. Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events. J Am Heart Assoc 2023; 12:e025581. [PMID: 36926956 PMCID: PMC10111542 DOI: 10.1161/jaha.122.025581] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background Although there is research on the impact of social determinants of health (SDOHs) on cardiovascular health, most existing evidence is based on individual SDOH components. We evaluated the impact of cumulative SDOH burden on cardiovascular risk factors, subclinical atherosclerosis, and incident cardiovascular disease events. Methods and Results We included 6479 participants from the MESA (Multi-Ethnic Study of Atherosclerosis). A weighted aggregate SDOH score representing the cumulative number of unfavorable SDOHs, identified from 14 components across 5 domains (economic stability, neighborhood and physical environment, community and social context, education, and health care system access) was calculated and divided into quartiles (quartile 4 being the least favorable). The impact of cumulative SDOH burden on cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, and obesity), systemic inflammation, subclinical atherosclerosis, and incident cardiovascular disease was evaluated. Increasing social disadvantage was associated with increased odds of all cardiovascular risk factors except dyslipidemia. Smoking was the risk factor most strongly associated with worse SDOH (odds ratio [OR], 2.67 for quartile 4 versus quartile 1 [95% CI, 2.13-3.34]). Participants within SDOH quartile 4 had 33% higher odds of increased high-sensitivity C-reactive protein (OR, 1.33 [95% CI, 1.11-1.60]) and 31% higher risk of all cardiovascular disease (hazard ratio, 1.31 [95% CI, 1.03-1.67]), yet no greater burden of subclinical atherosclerosis (OR, 1.01 [95% CI, 0.79-1.29]), when compared with those in quartile 1. Conclusions Increasing social disadvantage was associated with more prevalent cardiovascular risk factors, inflammation, and incident cardiovascular disease. These findings call for better identification of SDOHs in clinical practice and stronger measures to mitigate the higher SDOH burden among the socially disadvantaged to improve cardiovascular outcomes.
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Affiliation(s)
- Isaac Acquah
- Center for Outcomes Research Houston Methodist Houston TX
| | - Kobina Hagan
- Center for Outcomes Research Houston Methodist Houston TX
| | - Zulqarnain Javed
- Division of Health Disparities and Equity Research Center for Outcomes Research, Houston Methodist Houston TX
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Nwabunie Nwana
- Center for Outcomes Research Houston Methodist Houston TX
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Martha Gulati
- Division of Cardiology University of Arizona (Phoenix) Phoenix AZ
| | | | - Michael D Shapiro
- Section of Cardiovascular Medicine Wake Forest School of Medicine Winston Salem NC
| | - Ron Blankstein
- Cardiovascular Imaging Program, Department of Medicine and Radiology Brigham and Women's Hospital Boston MA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research Houston Methodist Houston TX
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Khurram Nasir
- Center for Outcomes Research Houston Methodist Houston TX
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
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50
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Taha MB, Cainzos-Achirica M, Elizondo JV, Lahan S, Heidari B, Patel K, Ali SS, Saxena A, Feldman T, Blaha MJ, Shapiro MD, Blankstein R, Sharma G, Budoff MJ, Cury RC, Fialkow JA, Nasir K. CORONARY PLAQUE CHARACTERISTICS IN ASYMPTOMATIC ADULTS ACROSS BMI CATEGORIES - THE MIAMI HEART STUDY AT BAPTIST HEALTH SOUTH FLORIDA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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